Individual
VICTORIA LYNN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
79 BONNYMEDE RD, APT 104, PUEBLO, CO 81001-8100
(720) 985-4453
Mailing address
79 BONNYMEDE RD APT 104, PUEBLO, CO 81001-1313
(720) 985-4453
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
09/19/2017
Last updated
09/19/2017
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