Darrell Dewayne Wallace Jr., LGPC
Counselor, Mental Health in Baltimore, MD. Individual provider (NPI-1).
NPI number1265086367
StatusActive
Last updated in NPPESJul 26, 2019
Details
- NPI
- 1265086367
- Entity type
- Individual (NPI-1)
- Name
- Mr. Darrell Dewayne Wallace Jr.
- Credential
- LGPC
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 26, 2019
- Last updated
- Jul 26, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | LGP9687 | MD | Yes |
Practice location
107 E 25th StBaltimore, MD 21218-5213
Phone 410-558-0019
Mailing address
553 Marc Rd # AMillersville, MD 21108-1525
Phone 443-694-7554
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