Individual
MR. SYLVESTER DARREN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW, ACSW, C-ASWCM
Contact information
Practice address
3701 LOOP RD, SOCIAL WORK SERVICE 122, TUSCALOOSA, AL 35404-5015
(205) 554-2000
(205) 554-3556
Mailing address
7651 HIGHWAY 69 NORTH, APT 815, NORTHPORT, AL 35473-7862
(205) 339-6098
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
MSW002075
GA
Other
Enumeration date
08/30/2006
Last updated
07/08/2007
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