Individual
LOWELL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1120 E MAIN ST STE 24, PHILADELPHIA, MS 39350-2300
(601) 781-8677
(601) 207-7720
Mailing address
1120 E MAIN ST STE 24, PHILADELPHIA, MS 39350-2300
(601) 781-8677
(601) 207-7720
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
10/20/2017
Last updated
03/17/2018
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