Individual
MRS. CONNIE L. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC-S
Contact information
Practice address
6435 E BROAD ST, COLUMBUS, OH 43213-1507
(614) 355-8160
(614) 355-8180
Mailing address
700 CHILDRENS DR, COLUMBUS, OH 43205-2664
(614) 722-2000
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
E.0004373-SUPV
OH
Other
Enumeration date
10/02/2006
Last updated
04/23/2025
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