Healthcare Provider Details

I. General information

NPI: 1003382938
Provider Name (Legal Business Name): EDWINA G WALLACE MORROW L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EDWINA WALLACE LPC

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 09/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 S. SHORE DR. SUITE 214
BATTLE CREEK MI
49014-5446
US

IV. Provider business mailing address

150 MORGAN RD
BATTLE CREEK MI
49017
US

V. Phone/Fax

Practice location:
  • Phone: 269-964-0153
  • Fax: 855-877-5812
Mailing address:
  • Phone: 269-245-1142
  • Fax: 269-966-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401222814
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401011732
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: