Individual
JANISE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
83 HOFFER LN SE, LUDOWICI, GA 31316
(254) 238-9473
Mailing address
83 HOFFER LN SE, LUDOWICI, GA 31316
(254) 238-9473
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW007370
GA
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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