Individual
HOLLY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
413 W TYLER AVE, WEST MEMPHIS, AR 72301-4149
(870) 733-1200
(870) 732-3269
Mailing address
413 W TYLER AVE, WEST MEMPHIS, AR 72301-4149
(870) 733-1200
(870) 732-3269
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
PLMSW
AR
Other
Enumeration date
07/02/2012
Last updated
07/02/2012
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