Individual
TARKISHA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-S, NCC
Contact information
Practice address
1000 CHINABERRY DR STE 902, BOSSIER CITY, LA 71111-2455
(318) 742-3408
Mailing address
1000 CHINABERRY DR STE 902, BOSSIER CITY, LA 71111-2455
(318) 742-3408
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4405
LA
Other
Enumeration date
04/28/2015
Last updated
09/06/2019
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