Individual
JENNIFER DAWN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC/S
Contact information
Practice address
204 BEVINS LN STE A, GEORGETOWN, KY 40324-6145
(859) 951-9777
(859) 951-9779
Mailing address
204 BEVINS LN STE A, GEORGETOWN, KY 40324-6145
(859) 951-9777
(859) 951-9779
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
104157
KY
101YP2500X
Professional Counselor
Primary
104157
—
Other
Enumeration date
03/12/2020
Last updated
11/20/2020
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