Individual
ANTONE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LSW
Contact information
Practice address
1490 E MAIN ST, COLUMBUS, OH 43205-2140
(614) 252-0731
Mailing address
353 HEMHILL DR, GALLOWAY, OH 43119-2200
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S1502544
OH
Other
Enumeration date
06/13/2016
Last updated
06/13/2016
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