Individual
REBECCA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
207 PEACH WAY, COLUMBIA, MO 65203-4905
(573) 777-8775
Mailing address
1800 N GARTH AVE, COLUMBIA, MO 65202-1547
(314) 308-0946
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2018039326
MO
Other
Enumeration date
09/24/2020
Last updated
09/24/2020
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