Individual
MS. SHAWNA ALEXANDRIA WALLACE-FOSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. LPC
Contact information
Practice address
230 GOODMAN RD E STE 204, SOUTHAVEN, MS 38671-8313
(662) 622-1838
(833) 355-5044
Mailing address
7550 AIRWAYS BLVD UNIT 1567, SOUTHAVEN, MS 38671-6378
(662) 200-7331
(833) 355-5044
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
2680
MS
Other
Enumeration date
06/07/2010
Last updated
11/14/2022
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