Individual
MICHAEL WAYNE WALLINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
904 E FAIRVIEW LN # B, ESPANOLA, NM 87532-2822
(505) 747-1991
(505) 753-6462
Mailing address
PO BOX KK, TAOS, NM 87571-1570
(505) 751-7037
(505) 751-3010
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2331
NM
Other
Enumeration date
01/26/2007
Last updated
07/08/2007
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