Individual
KAITLYN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-MHSP
Contact information
Practice address
1360 MACKEY BRANCH DR, CHATTANOOGA, TN 37421-3225
(423) 443-3336
Mailing address
1360 MACKEY BRANCH DR, CHATTANOOGA, TN 37421-3225
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6374
TN
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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