Individual
MR. WILLIE JAMES WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
835 PRIDE DR, HAMMOND, LA 70401-9527
(985) 543-4730
(985) 543-4752
Mailing address
835 PRIDE DR, HAMMOND, LA 70401-9527
(985) 543-4730
(985) 543-4752
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4852
LA
Other
Enumeration date
02/19/2013
Last updated
02/19/2013
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