Individual
CASSANDRA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTN
Contact information
Practice address
4601 W 7TH ST, LITTLE ROCK, AR 72205-5441
(501) 686-9393
Mailing address
4601 W 7TH ST, LITTLE ROCK, AR 72205-5441
(501) 686-9393
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
1658
AR
Other
Enumeration date
05/15/2008
Last updated
05/15/2008
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