Individual
CONSTANCE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., LPC
Contact information
Practice address
1222 LINCOLN COURT AVE NE, ATLANTA, GA 30329-1825
(678) 641-4415
Mailing address
1222 LINCOLN COURT AVE NE, ATLANTA, GA 30329-1825
(678) 641-4415
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC005431
GA
Other
Enumeration date
07/18/2009
Last updated
07/18/2009
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