Individual
FANNIE BEATRICE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
180 MEDICAL PARK PL, HOT SPRINGS, AR 71901-8065
(501) 521-1942
(501) 359-3010
Mailing address
PO BOX 497, AUGUSTA, AR 72006-0497
(870) 347-2534
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
A2005077
AR
101YP2500X
Professional Counselor
Primary
P2205002
AR
Other
Enumeration date
02/20/2017
Last updated
04/25/2025
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