Individual
MS. SUSAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
122 CLEBOURNE ST, FORT MILL, SC 29715-1753
(704) 931-1010
Mailing address
335 KENNEBEL PL, FORT MILL, SC 29715-4101
(980) 613-1443
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
COU10796
SC
171400000X
Health & Wellness Coach
—
SC
Other
Enumeration date
12/12/2025
Last updated
12/22/2025
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