Individual
DEBRA J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PCC-S, LICDC
Contact information
Practice address
1207 W STATE ST, SUITE F, ALLIANCE, OH 44601-4686
(330) 821-3846
(330) 821-5172
Mailing address
625 CLEVELAND AVE NW, CANTON, OH 44702-1805
(330) 453-8252
(330) 453-6716
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.151044-CS
OH
101YP2500X
Professional Counselor
Primary
E.0900224-SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0182777
—
OH
Enumeration date
12/23/2010
Last updated
03/01/2017
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