Individual
CHRISTOPHER WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
118 VILLAGE ST STE A, SLIDELL, LA 70458-5302
(504) 782-5849
Mailing address
8326 KELWOOD AVE, BATON ROUGE, LA 70806-4803
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
LA
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/22/2015
Last updated
06/10/2024
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