Individual
DASHIYA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4812 BALTIMORE AVE, PHILADELPHIA, PA 19143-3419
(215) 563-7863
Mailing address
4812 BALTIMORE AVE, PHILADELPHIA, PA 19143-3419
(215) 563-7863
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW136536
PA
Other
Enumeration date
03/29/2021
Last updated
03/29/2021
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