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General NPI Number Information
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NPI Number | 1457280828
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Entity Type | Organization
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Legal Business Name | DANA J. WALLACE, LCSW, LLC
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Dates
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Enumeration Date | 05/14/2026
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Last Update Date | 05/14/2026
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Provider Practice Location Address
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Address Line | 480 SANTA ROSA BLVD UNIT 308E
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-6945
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Country | US
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Telephone | 251-421-0712
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Fax |
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Provider Business Mailing Address
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Address Line | 480 SANTA ROSA BLVD UNIT 308E
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-6945
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Country | US
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Telephone | 251-421-0712
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER/PSYCHTHERAPIST
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Name | DANA JANELLE WALLACE
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Credential | LCSW, LICSW
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Telephone | 251-421-0712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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