Individual
RICKY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10512 INNISBROOK DRIVE, JACKSONVILLE, FL 32222
(904) 534-4937
(800) 863-2339
Mailing address
10512 INNISBROOK DR, JACKSONVILLE, FL 32222-1363
(904) 534-4937
(800) 863-2339
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
06/22/2011
Last updated
06/22/2011
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