Individual
TENESHA JEANELLE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
12774 WISTERIA DR UNIT 163, GERMANTOWN, MD 20875-7507
(240) 484-5585
Mailing address
12774 WISTERIA DR UNIT 163, GERMANTOWN, MD 20875-7507
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
31141
MD
104100000X
Social Worker
LG200002744
DC
Other
Enumeration date
07/29/2024
Last updated
07/29/2024
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