Individual
MR. CHARLES WILLIAM WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
5738 OLDE WADSWORTH BLVD, ARVADA, CO 80002-2535
(720) 203-2903
Mailing address
1370 ESTES ST APT 201, LAKEWOOD, CO 80215-4866
(303) 295-3326
(775) 402-0854
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
749
CO
Other
Enumeration date
05/14/2007
Last updated
07/08/2007
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