Individual
ALEXIS D WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPSS
Contact information
Practice address
80 HIGHWAY 2227, SOMERSET, KY 42503-1562
(606) 485-4003
Mailing address
80 HIGHWAY 2227, SOMERSET, KY 42503-1562
(606) 485-4003
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
296874
KY
175T00000X
Peer Specialist
Primary
1207173
KY
Other
Enumeration date
07/26/2023
Last updated
01/20/2025
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