Individual
CYNTHIA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
19 E BIRCH ST STE 103, WALLA WALLA, WA 99362-3084
(509) 200-7290
Mailing address
553 LOCUST ST, WALLA WALLA, WA 99362-3338
(509) 200-7290
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW00009476
WA
Other
Enumeration date
05/24/2012
Last updated
05/24/2012
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