Individual
MR. DUSTIN WADE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4619 W SAGUARO DR, GLENDALE, AZ 85304-4424
(602) 999-3355
Mailing address
4619 W SAGUARO DR, GLENDALE, AZ 85304-4424
(602) 999-3355
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-21756
—
Other
Enumeration date
10/24/2020
Last updated
08/29/2023
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