Individual
CAMILLA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1007 CHURCH ST, SUITE 302, EVANSTON, IL 60201-3624
(847) 492-1938
(847) 423-5670
Mailing address
1007 CHURCH ST, SUITE 302, EVANSTON, IL 60201-3624
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.013306
IL
1041C0700X
Clinical Social Worker
6801093324
MI
Other
Enumeration date
11/21/2007
Last updated
09/16/2013
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