Individual
MR. DARRELL DEWAYNE WALLACE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LGPC
Contact information
Practice address
107 E 25TH ST, BALTIMORE, MD 21218-5213
(410) 558-0019
Mailing address
553 MARC RD # A, MILLERSVILLE, MD 21108-1525
(443) 694-7554
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LGP9687
MD
Other
Enumeration date
07/26/2019
Last updated
07/26/2019
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