Individual
MRS. ERIN MELISSA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS/CADC
Contact information
Practice address
16338 N IL HIGHWAY 37, MOUNT VERNON, IL 62864-8178
(618) 242-5835
(618) 242-6392
Mailing address
16338 N IL HIGHWAY 37, MOUNT VERNON, IL 62864-8178
(618) 242-5835
(618) 242-6392
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649404708
—
IL
Enumeration date
10/04/2017
Last updated
10/04/2017
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