Individual
JESSICA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, NCC
Contact information
Practice address
10414 JACKSON OAKS WAY STE 103, KNOXVILLE, TN 37922-0704
(865) 567-2899
Mailing address
5004 JENKINS RD, KNOXVILLE, TN 37918-2227
(865) 567-2899
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6639
TN
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
Other
Enumeration date
05/20/2011
Last updated
05/06/2024
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