Individual
JULIA LYNETTE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TEMPORARY CSW
Contact information
Practice address
1175 CANE VALLEY RD, COLUMBIA, KY 42728-9540
(270) 384-6750
Mailing address
25640 LOUISVILLE RD, PARK CITY, KY 42160-7729
(270) 250-4733
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
258426
KY
Other
Enumeration date
09/25/2023
Last updated
09/25/2023
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