Individual
MR. HENRY NEAL WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CIT
Contact information
Practice address
10473 OLD HAMMOND HWY, BATON ROUGE, LA 70816-8264
(225) 683-4144
Mailing address
1184 HARCO DR, BATON ROUGE, LA 70815-2916
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/23/2019
Last updated
03/23/2019
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