Individual
MRS. STACY GARRETT WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
105 SAINT STEPHENS CT, TYRONE, GA 30290-1716
(770) 378-9913
Mailing address
74 PRICE DR W, LOCUST GROVE, GA 30248-2540
(770) 378-9913
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW002388
GA
Other
Enumeration date
10/13/2022
Last updated
10/13/2022
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