Individual
MR. NICHOLAS PRESTON WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, NCC, CCMHC
Contact information
Practice address
90 KINGSTON XING APT 1506, BOSSIER CITY, LA 71111-6289
(318) 935-0105
Mailing address
90 KINGSTON XING APT 1506, BOSSIER CITY, LA 71111-6289
(318) 210-8499
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC #5493
LA
101YP2500X
Professional Counselor
Primary
LPC #5493
LA
Other
Enumeration date
11/17/2014
Last updated
06/06/2021
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