Individual
MRS. ANNE MARIE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1505 N FLORIDA ST, COVINGTON, LA 70433-1544
(985) 900-1626
Mailing address
21226 CASRIL DR, MANDEVILLE, LA 70471-7614
(504) 491-0210
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6914
LA
Other
Enumeration date
12/23/2020
Last updated
12/23/2020
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