Individual
ANITA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 E FOOTHILL BLVD, PASADENA, CA 91107-3464
(626) 564-1613
Mailing address
2500 E FOOTHILL BLVD, PASADENA, CA 91107-3464
(626) 564-1613
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFC 44773
CA
Other
Enumeration date
07/08/2009
Last updated
07/08/2009
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