Individual
JENNA E WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
3729 TEAYS VALLEY RD, STE 100, HURRICANE, WV 25526-9705
(304) 760-6040
(304) 760-6042
Mailing address
2585 3RD AVE, HUNTINGTON, WV 25703-1642
(304) 697-1396
(304) 697-2086
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
WV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/21/2015
Last updated
04/08/2022
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