Individual
DIANA TYSON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATR, PC
Contact information
Practice address
3737 LANDER RD, CLEVELAND, OH 44124-5712
(216) 831-2255
Mailing address
3737 LANDER RD, CLEVELAND, OH 44124-5712
(216) 831-2255
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
C. 1000308
OH
101YP2500X
Professional Counselor
Primary
E.1700151
OH
221700000X
Art Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2871101
—
OH
Enumeration date
03/26/2013
Last updated
04/10/2017
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