Individual
AUTUMN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
2299 WOODBURY AVE STE 1, NEWINGTON, NH 03801-7854
(603) 244-3187
Mailing address
2299 WOODBURY AVE STE 1, NEWINGTON, NH 03801-7854
(603) 244-3187
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3078870
—
NH
Enumeration date
11/15/2023
Last updated
10/27/2025
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