Individual
KRISTINA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
134 DOGWOOD DR, CROSS JUNCTION, VA 22625-2501
(302) 528-8047
Mailing address
134 DOGWOOD DR, CROSS JUNCTION, VA 22625-2501
(130) 252-8804
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0701011020
VA
101YP2500X
Professional Counselor
Primary
0701011020
VA
Other
Enumeration date
06/20/2022
Last updated
06/20/2022
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