Individual
KATHLEEN MICHELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, NCC
Contact information
Practice address
110 SKYLINE DR, RUSSELLVILLE, AR 72801-3362
(479) 968-1298
(479) 890-5364
Mailing address
110 SKYLINE DR, RUSSELLVILLE, AR 72801-3362
(479) 967-5570
(479) 890-5364
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
P1507083
AR
Other
Enumeration date
05/19/2010
Last updated
02/15/2016
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