Individual
MR. COLEMAN W WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15 EDGE CT, WILLINGBORO, NJ 08046-2412
(609) 500-7139
Mailing address
15 EDGE CT, WILLINGBORO, NJ 08046-2412
(609) 500-7139
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
—
NJ
Other
Enumeration date
08/28/2023
Last updated
08/30/2023
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