Individual
NICOLE JANEEN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHC
Contact information
Practice address
3041 BERKS WAY STE 102C, RALEIGH, NC 27614-6777
(919) 925-2274
(919) 820-8571
Mailing address
PO BOX 627, WAKE FOREST, NC 27588-0627
(919) 306-2579
(919) 820-8571
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
A13547
NC
Other
Enumeration date
02/08/2018
Last updated
01/05/2021
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