Individual
DONNA LOUISE MARTIN-WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC, LADC, ADCR-MN
Contact information
Practice address
2970 JUDICIAL RD STE 100, BURNSVILLE, MN 55337-7822
(952) 224-8990
(952) 224-8991
Mailing address
14024 NATCHEZ AVE, SAVAGE, MN 55378-2002
(612) 220-3247
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC03103
MN
Other
Enumeration date
01/13/2022
Last updated
01/13/2022
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