Individual
DIANA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1 NUNN DR, UNIVERSITY CENTER, SUITE 440, NEWPORT, KY 41099-0002
(859) 572-5650
(859) 572-5615
Mailing address
1 NUNN DR, UNIVERSITY CENTER, SUITE 440, NEWPORT, KY 41099-0002
(859) 572-5650
(859) 572-5615
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
005144
CT
1041C0700X
Clinical Social Worker
Primary
3632
KY
Other
Enumeration date
06/23/2005
Last updated
06/12/2012
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