Individual
CAROLYN ANN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCADC
Contact information
Practice address
2600 W BROADWAY, LOUISVILLE, KY 40211-1366
(502) 690-4286
Mailing address
323 N 42ND ST, LOUISVILLE, KY 40212-2747
(502) 356-8210
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
260417
KY
Other
Enumeration date
02/27/2020
Last updated
05/06/2020
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