Individual
MRS. GENNIFER WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
7509 CHARLESTOWN PIKE, CHARLESTOWN, IN 47111-9623
(812) 256-4686
(812) 256-4415
Mailing address
7509 CHARLESTOWN PIKE, CHARLESTOWN, IN 47111-9623
(812) 256-4686
(812) 256-4415
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
IN
Other
Enumeration date
02/15/2016
Last updated
02/15/2016
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