Individual
MR. BARRY RAY WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2101 GARNER RD #107, RALEIGH, NC 27610-3790
(919) 787-6131
Mailing address
5440 EAGLE CLOUD TRL APT 301, RALEIGH, NC 27606-3790
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
25403
NC
101YM0800X
Mental Health Counselor
Primary
A15095
NC
Other
Enumeration date
06/04/2019
Last updated
08/27/2019
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