Individual
CHAUNCEY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
284 S STATE ST, MARION, OH 43302-3940
(614) 832-7647
(740) 375-5583
Mailing address
284 S STATE ST, MARION, OH 43302-3940
(614) 832-7647
(740) 375-5583
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
050034
OH
Other
Enumeration date
11/26/2018
Last updated
11/26/2018
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