Individual
MS. ANNA K WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
2235 LOCKSLEY WOODS DR APT E, GREENVILLE, NC 27858-5461
(252) 717-2600
Mailing address
2235 LOCKSLEY WOODS DR APT E, GREENVILLE, NC 27858-5461
(252) 717-2600
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
12247A
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497989842
—
NC
Enumeration date
10/21/2020
Last updated
10/21/2020
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