Individual
LORETTA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
60 E 112TH ST APT 402, NEW YORK, NY 10029-0314
(646) 245-7639
Mailing address
60 E 112TH ST APT 402, NEW YORK, NY 10029-0314
(646) 245-7639
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
41880
NY
Other
Enumeration date
04/18/2026
Last updated
04/18/2026
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