Mellani Maritza Wallace
NPI #1033799499 in Brandon, Mississippi
Provider Information
- NPI Number
- 1033799499
- Entity Type
- Individual
- Name
- Mellani Maritza Wallace
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Counselor
- Enumeration Date
- Apr 10, 2021
- Last Updated
- Apr 10, 2021
Practice Location
- Address
- 613 MARQUETTE RD
- City
- Brandon
- State
- Mississippi
- ZIP Code
- 39042-3038
- Phone
- (601) 591-5553
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor |
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