Individual
MR. ANTHONY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MASTER
Contact information
Practice address
2222 PONCE DE LEON BLVD FL 3, CORAL GABLES, FL 33134-5039
(866) 305-7365
Mailing address
2222 PONCE DE LEON BLVD FL 3, CORAL GABLES, FL 33134-5039
(866) 305-7365
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
03/07/2018
Last updated
03/07/2018
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