Individual
DANA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LICSW
Contact information
Practice address
480 SANTA ROSA BLVD, FORT WALTON BEACH, FL 32548-6901
(251) 421-0712
Mailing address
480 SANTA ROSA BLVD UNIT 308E, FORT WALTON BEACH, FL 32548-6945
(251) 421-0712
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
6143C
AL
1041C0700X
Clinical Social Worker
Primary
SW24920
FL
Other
Enumeration date
08/29/2017
Last updated
05/06/2026
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