Individual
MARY ETHERIDGE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
303 E. MAIN STREET SUITE 9, ELIZABETH CITY, NC 27909
(252) 619-6629
(252) 331-2499
Mailing address
303 E. MAIN STREET SUITE 9, ELIZABETH CITY, NC 27909-4452
(252) 619-6629
(252) 331-2499
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
0701005385
VA
101YP2500X
Professional Counselor
Primary
12837
NC
Other
Enumeration date
02/27/2013
Last updated
09/06/2018
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