Individual
DANNA KAYE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, CSW, CABIP
Contact information
Practice address
730 FAIRVIEW AVE, BOWLING GREEN, KY 42101-2367
(270) 904-0201
(270) 904-0221
Mailing address
730 FAIRVIEW AVE, BOWLING GREEN, KY 42101-2367
(270) 904-0201
(270) 904-0221
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
05202012
KY
101YM0800X
Mental Health Counselor
05202012
KY
101YP2500X
Professional Counselor
Primary
05202012
—
Other
Enumeration date
07/24/2012
Last updated
07/24/2012
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