Individual
ANNISHA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
610 E BASELINE RD STE 5, PHOENIX, AZ 85042-6536
(602) 230-7373
(602) 441-5836
Mailing address
3101 N CENTRAL AVE STE 550, PHOENIX, AZ 85012-2635
(602) 230-7373
(602) 682-7455
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW-18807
AZ
1041C0700X
Clinical Social Worker
Primary
LCSW-21745
AZ
Other
Enumeration date
09/13/2022
Last updated
11/30/2023
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