Individual
LISA ANNE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, NCC, CCNHC
Contact information
Practice address
418 BARR RD, LEXINGTON, SC 29072-2363
(803) 707-4945
Mailing address
300 PALMETTO PARK BLVD APT 216, LEXINGTON, SC 29072-7877
(803) 707-4945
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7291
SC
Other
Enumeration date
10/31/2019
Last updated
10/31/2019
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