Individual
CASEY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2045 E WEST MAPLE RD STE D405, COMMERCE TOWNSHIP, MI 48390-3801
(248) 669-9500
Mailing address
201 W NEW YORK AVE, PONTIAC, MI 48340-1154
(810) 893-4363
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6362009880
MI
Other
Enumeration date
05/13/2021
Last updated
01/04/2024
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