Individual
BAKARI WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2888 W GRAND BLVD, DETROIT, MI 48202-2612
(313) 874-8715
Mailing address
14882 PIEDMONT ST, DETROIT, MI 48223-2243
(313) 208-0466
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
MI
Other
Enumeration date
10/02/2014
Last updated
10/02/2014
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