Individual
ANDREW NATHAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
191 LAMAR HALEY PKWY, CANTON, GA 30114-8019
(770) 704-1600
Mailing address
1193 WADE GREEN CIR NW, ACWORTH, GA 30102-3491
(770) 866-6851
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW008417
GA
Other
Enumeration date
02/21/2023
Last updated
04/25/2023
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