Individual
MRS. DIANE TAMARA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
1830 MANOR DR, UNION, NJ 07083-4617
(973) 978-2858
Mailing address
1830 MANOR DR, UNION, NJ 07083-4617
(973) 978-2858
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
37AC00711600
NJ
Other
Enumeration date
10/25/2024
Last updated
10/25/2024
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