Individual
MEG WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
297 HERNDON PKWY, SUITE 201, HERNDON, VA 20170-4474
(703) 435-4325
(703) 435-4325
Mailing address
12807 KETTERING DR, HERNDON, VA 20171-2446
(703) 435-4325
(703) 435-4325
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1808
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0600001
CARE 1ST ID
VA
01
—
200642
ANTHEM ID
VA
Enumeration date
08/21/2006
Last updated
07/08/2007
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