Individual
MS. DEBORAH FAYE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC LICENSED CLINIC
Contact information
Practice address
18772 RT. 4, CARLINVILLE, IL 62626
(217) 854-2712
Mailing address
17232 PARKSIDE DRIVE, CARLINVILLE, IL 62626
(217) 827-0523
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180.003816
IL
Other
Enumeration date
03/19/2024
Last updated
03/19/2024
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