Individual
AZAIA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8039 LENNOX LOOP, WESLEY CHAPEL, FL 33544-3503
(918) 859-5775
Mailing address
8039 LENNOX LOOP, WESLEY CHAPEL, FL 33544-3503
(918) 859-5775
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
10883-C
NV
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
04/29/2021
Last updated
09/04/2024
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