Individual
DENISE MARIE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFTA
Contact information
Practice address
1315 WEATHERBEE DR., WINSTON-SALEM, NC 27103
(919) 200-8734
Mailing address
1315 WEATHERBEE DR., WINSTON-SALEM, NC 27103
(919) 200-8734
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
10053A
NC
Other
Enumeration date
04/30/2015
Last updated
09/22/2021
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