Individual
DONNA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2110 SW 97 LANE, DAVIE, FL 33324
(954) 424-1023
(954) 916-1217
Mailing address
2110 SW 97 LANE, DAVIE, FL 33324
(954) 424-1023
(954) 916-1217
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW2636
FL
Other
Enumeration date
05/04/2007
Last updated
07/08/2007
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