Individual
ALICIA D WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
3312 TEASLEY LN, DENTON, TX 76210-8311
(402) 222-3999
Mailing address
9021 BENEVOLENT CT, AUBREY, TX 76227-1303
(903) 821-8786
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
74421
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74421
TEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS
TX
Enumeration date
05/15/2018
Last updated
01/31/2023
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