Kristin Wallace
NPI #1154931129 in Madison, Mississippi
Provider Information
- NPI Number
- 1154931129
- Entity Type
- Individual
- Name
- Kristin Wallace
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Social Worker - Clinical
- Enumeration Date
- Aug 5, 2020
- Last Updated
- Aug 5, 2020
Practice Location
- Address
- 940 EBENEZER BLVD
- City
- Madison
- State
- Mississippi
- ZIP Code
- 39110-6002
- Phone
- (601) 790-0583
Specialties & Taxonomy Codes
| Specialty |
|---|
| Social Worker - Clinical — Clinical |
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