Individual
MRS. CONNIE J WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
1412 17TH ST # 352, BAKERSFIELD, CA 93301-5211
(661) 205-1522
(661) 872-3247
Mailing address
1412 17TH ST # 352, BAKERSFIELD, CA 93301-5211
(661) 205-1522
(661) 872-3247
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
MFC40616
CA
Other
Enumeration date
10/05/2006
Last updated
08/12/2010
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