Individual
MARIE C WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
18 BRIAN ST, CARROLLTON, KY 41008-8202
(150) 252-5853
Mailing address
4229 BARDSTOWN RD STE 204, LOUISVILLE, KY 40218-4271
(502) 936-6546
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
277200
KY
Other
Enumeration date
04/28/2022
Last updated
04/28/2022
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