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Individual

BRENETTA N. WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2770 MAIN ST STE 229, FRISCO, TX 75033-4459
(714) 797-6015
Mailing address
PO BOX 120692, ARLINGTON, TX 76012-0692
(714) 797-6015

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
65193
TX

Other

Enumeration date
10/30/2012
Last updated
01/12/2021
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