Individual
MS. JASMINE ALICIA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
145 MAPLE AVE, RED BANK, NJ 07701-1717
(732) 747-9660
(732) 224-1396
Mailing address
610 SEWALL AVE APT 5R, ASBURY PARK, NJ 07712-6540
(732) 747-9660
(732) 224-1396
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/29/2006
Last updated
07/08/2007
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