Individual
MISS CHRISTINA M WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1515 MICHELIN CT, LUTZ, FL 33549-7533
(813) 949-8946
(813) 949-2926
Mailing address
PO BOX 1907, LUTZ, FL 33548-1907
(813) 949-8946
(813) 949-2926
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW8447
FL
Other
Enumeration date
12/11/2008
Last updated
12/11/2008
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