Individual
STEVEN E WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
30800 CHAGRIN BLVD, CLEVELAND, OH 44124-5925
(216) 591-0324
(216) 591-1243
Mailing address
30800 CHAGRIN BLVD, CLEVELAND, OH 44124-5925
(216) 591-0324
(216) 591-1243
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
CDCA.162346
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2374229
—
OH
Enumeration date
12/16/2017
Last updated
12/16/2017
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