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General NPI Number Information
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NPI Number | 1154040954
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Entity Type | Individual
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Provider Name | ANNA LEESE WALLACE LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 30 GARFIELD ST STE A
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City | ASHEVILLE
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State | NC
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Zip | 28803-7301
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Country | US
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Telephone | 888-651-4212
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Fax |
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Provider Business Mailing Address
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Address Line | 15 CASTLEKNOCK DR APT 205
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City | ASHEVILLE
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State | NC
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Zip | 28803-4564
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Country | US
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Telephone | 864-915-8286
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | A17911
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License Number State | NC
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