Individual
MRS. ELAINE MARIE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
204 SOMERSET BAY DR APT 201, GLEN BURNIE, MD 21061-6476
(410) 903-8473
Mailing address
204 SOMERSET BAY DR APT 201, GLEN BURNIE, MD 21061-6476
(410) 903-8473
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC13561
MD
Other
Enumeration date
04/22/2021
Last updated
08/29/2023
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