Individual
CARLA R WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3465 N NORTHWOOD AVE, FAYETTEVILLE, AR 72704-5302
(285) 472-0882
Mailing address
3465 N NORTHWOOD AVE, FAYETTEVILLE, AR 72704-5302
(479) 338-2559
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW
AR
Other
Enumeration date
04/28/2021
Last updated
04/28/2021
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