Individual
RACHEL ANN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, CDPT
Contact information
Practice address
210 PACIFIC AVE N, KELSO, WA 98626-3414
(360) 423-0203
(360) 577-0269
Mailing address
PO BOX 1847, LONGVIEW, WA 98632-8140
(360) 423-0203
(360) 557-0269
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
60336482
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2101606
—
WA
Enumeration date
08/28/2017
Last updated
11/22/2019
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