Organization
WALLACE & ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA WALLACE PHD (OWNER)
(248) 557-3820
Entity
Organization
Contact information
Practice address
16000 W 9 MILE RD, SUITE 615, SOUTHFIELD, MI 48075-4808
(248) 557-3820
Mailing address
16000 W 9 MILE RD, SUITE 615, SOUTHFIELD, MI 48075-4808
(248) 557-3820
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PW05231
MI
Other
Enumeration date
05/08/2007
Last updated
08/22/2020
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