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Individual

AMAYA O. WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW-A, LCAS

Contact information

Practice address
6118 SAINT GILES ST STE 120, RALEIGH, NC 27612-7045
(984) 278-8449
Mailing address
6118 SAINT GILES ST STE 120, RALEIGH, NC 27612-7045

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
NC
104100000X
Social Worker
NC
1041C0700X
Clinical Social Worker
374J00000X
Doula

Other

Enumeration date
07/22/2024
Last updated
08/21/2025
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