Individual
MRS. AIMEE ROSE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
2451 EXECUTIVE DR STE 205, SAINT CHARLES, MO 63303-5606
(314) 375-6599
Mailing address
2451 EXECUTIVE DR STE 205, SAINT CHARLES, MO 63303-5606
(314) 375-6599
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
2022020122
—
Other
Enumeration date
10/09/2019
Last updated
05/08/2026
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