Individual
CHARMAINE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10467 RIVER ROAD, AMA, LA 70031-0703
(504) 431-3030
Mailing address
PO BOX 703, AMA, LA 70031-0703
(504) 431-3030
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/14/2016
Last updated
09/14/2016
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