Individual
MR. CHRISTOPHER PETER WALLACK I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
460 QUINCY AVE, QUINCY, MA 02169-8130
(239) 269-8276
Mailing address
85 AUSTIN ST, HYDE PARK, MA 02136-1532
(239) 269-8276
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/28/2020
Last updated
09/28/2020
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