Individual
MR. SAM LOC WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
1845 N GREEN ACRES RD, FAYETTEVILLE, AR 72703-2615
(479) 957-8546
Mailing address
1845 N GREEN ACRES RD, FAYETTEVILLE, AR 72703-2615
(479) 957-8546
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
P0702007
AR
Other
Enumeration date
03/24/2008
Last updated
04/08/2015
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