Healthcare Provider Details

I. General information

NPI: 1295890838
Provider Name (Legal Business Name): JOYCE ANN WALLACE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 CENTER HILL RD.
PLYMOUTH MA
02360
US

IV. Provider business mailing address

257 CENTER HILL RD.
PLYMOUTH MA
02360
US

V. Phone/Fax

Practice location:
  • Phone: 617-595-6066
  • Fax: 508-888-4202
Mailing address:
  • Phone: 617-595-6066
  • Fax: 508-888-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4420
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: