Individual
KATHRYN MICHELE WALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
1931 UNION CROSS RD, WINSTON SALEM, NC 27107-6448
(336) 784-9470
(336) 784-9505
Mailing address
1931 UNION CROSS RD, WINSTON SALEM, NC 27107-6448
(336) 784-9470
(336) 784-9505
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2787
NC
Other
Enumeration date
11/09/2012
Last updated
11/09/2012
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