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General NPI Number Information
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NPI Number | 1851282784
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Entity Type | Organization
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Legal Business Name | WALLACE COUNSELING AND WELLNESS
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 420 RIDGEWOOD ST
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-7822
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Country | US
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Telephone | 239-738-3449
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Fax |
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Provider Business Mailing Address
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Address Line | 420 RIDGEWOOD ST
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-7822
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | KASIE WALLACE
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Credential | M.A., LMHC, QS
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Telephone | 239-738-3449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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