Individual
LULA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAC-AD
Contact information
Practice address
821 N EUTAW ST, BALTIMORE, MD 21201-4648
(410) 225-9185
Mailing address
4108 FALLSTAFF RD, BALTIMORE, MD 21215-1411
(443) 660-9929
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACO333
MD
Other
Enumeration date
08/31/2023
Last updated
08/31/2023
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