Individual
STEPHANIE L WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
1212 HANCOCK ST STE 205, QUINCY, MA 02169-4371
(617) 750-0183
Mailing address
1212 HANCOCK ST STE 205, QUINCY, MA 02169-4371
(617) 750-0183
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1699
MA
Other
Enumeration date
03/25/2020
Last updated
03/25/2020
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