Individual
MRS. COLLEEN CARVER WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1150 SCIOTO ST, URBANA, OH 43078-2289
(937) 652-4555
Mailing address
220 E PATTERSON AVE, BELLEFONTAINE, OH 43311-1959
(937) 292-7687
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
05/30/2007
Last updated
07/08/2007
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