Individual
MS. TARA GRACE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
900 DOUGLAS PIKE STE 220, SMITHFIELD, RI 02917-1879
(401) 452-0123
(401) 941-7847
Mailing address
28 BIRCHTREE DR, JOHNSTON, RI 02919-3545
(401) 919-7233
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MHC01803
RI
Other
Enumeration date
11/07/2023
Last updated
06/19/2025
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