Individual
MAYNELL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
3964 WHEAT RIDGE RD, WEST UNION, OH 45693
(937) 544-0100
Mailing address
3964 WHEAT RIDGE RD, WEST UNION, OH 45693
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1600067
OH
Other
Enumeration date
09/12/2017
Last updated
08/26/2019
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