Individual
MS. MYKALA R WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
885 W CLYDESDALE DR, FAYETTEVILLE, AR 72701-8209
(479) 444-1670
(479) 445-6903
Mailing address
885 W CLYDESDALE DR, FAYETTEVILLE, AR 72701-8209
(479) 444-1670
(479) 445-6903
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
10102-M
AR
Other
Enumeration date
04/30/2021
Last updated
04/30/2021
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