Individual
DEBRA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
27979 N CONVERSE RD, ISLAND LAKE, IL 60042-8103
(847) 850-9444
Mailing address
39469 N SHORE DR, SPRING GROVE, IL 60081-9170
(847) 587-0475
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
166000901
IL
Other
Enumeration date
02/20/2013
Last updated
02/20/2013
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