Individual
DEDRA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1302 CHINOOK LN, PUEBLO, CO 81001-1851
(719) 545-2746
(719) 545-4100
Mailing address
41 MONTEBELLO ROAD, SUITE 200, PUEBLO, CO 81004-1128
(719) 545-2746
(719) 545-4100
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC.0013214
CO
Other
Enumeration date
12/10/2014
Last updated
10/19/2016
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