Individual
AMANDA KAY FACKLER WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
8480 N 32ND ST UNIT 92, RICHLAND, MI 49083-9817
(269) 215-5753
Mailing address
5228 LOVERS LN STE 102, PORTAGE, MI 49002-1521
(810) 837-2046
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
6451022560
MI
101YP2500X
Professional Counselor
Primary
6401224616
MI
Other
Enumeration date
01/24/2023
Last updated
02/25/2026
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