Individual
LASHANDA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
444 CENTER ST, MANCHESTER, CT 06040-3926
(860) 646-3888
Mailing address
444 CENTER ST, MANCHESTER, CT 06040-3926
(860) 646-3888
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
CT
Other
Enumeration date
11/23/2020
Last updated
04/04/2022
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