Individual
DENISE ELIZABETH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LLP
Contact information
Practice address
7310 WOODWARD AVE STE 401, DETROIT, MI 48202-3165
(313) 550-8810
Mailing address
7310 WOODWARD AVE STE 401, DETROIT, MI 48202-3165
(313) 550-8810
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301009769
MI
Other
Enumeration date
12/11/2017
Last updated
12/11/2017
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