Individual
DENESE RENEE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3436 MARY ELDER RD NE, OLYMPIA, WA 98506-5050
(360) 528-2590
Mailing address
PO BOX 33, ELMA, WA 98541-0033
(425) 404-9575
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP61462202
WA
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
03/03/2020
Last updated
01/09/2024
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