Individual
MRS. CHULETE AURIELLE WALLACE-KEANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3280 MITCHELL BLVD, MOODY AFB, GA 31699-1500
(229) 257-2778
Mailing address
3280 MITCHELL BLVD, MOODY AFB, GA 31699-1500
(229) 257-3898
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C010976
NC
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
02/20/2015
Last updated
12/04/2023
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