Individual
O'KEITH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS, MS, CAMS11
Contact information
Practice address
4830 LAWRENCEVILLE HWY NW STE 2B, LILBURN, GA 30047-3812
(770) 676-9216
Mailing address
4830 LAWRENCEVILLE HWY NW STE 2B, LILBURN, GA 30047-3812
(770) 676-9216
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/21/2020
Last updated
05/21/2020
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