Individual
KAREN MARIE WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., PCC, LCDC III
Contact information
Practice address
29325 CHAGRIN BLVD, SUITE #102, BEACHWOOD, OH 44122-4600
(216) 548-0523
Mailing address
PO BOX 158, RICHFIELD, OH 44286-0158
(216) 548-0523
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
091014
OH
101YM0800X
Mental Health Counselor
Primary
E. 0500432
OH
Other
Enumeration date
11/07/2009
Last updated
11/07/2009
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