Individual
MR. MARK ALLEN WALLMAN SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.C., L.C.A.D.C.
Contact information
Practice address
314 KELLY LN, BOONTON, NJ 07005-2110
(973) 334-6006
Mailing address
314 KELLY LN, BOONTON, NJ 07005-2110
(973) 334-6006
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00156700
NJ
101YP2500X
Professional Counselor
Primary
37PC00384900
NJ
Other
Enumeration date
11/05/2008
Last updated
05/06/2009
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