Alicia S Wallace
Alicia S Wallace is a Mental Health Counselor in Bloomington, Illinois. Practices as a sole proprietor. Registered with an NPI since 2024.
- In the registry since
- 2024
Practice location Address checks out
108 W Market StBloomington, IL 61701-3918
Phone: (309) 827-5351
Fax: (309) 829-6808
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Specialties & licences
| Mental Health Counselor (primary) | Taxonomy 101YM0800X |
|---|
Record details
| NPI number | 1114746765 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | Yes |
| NPI enumerated | October 9, 2024 |
| Last updated in NPPES | October 9, 2024 |
| Certification date | October 9, 2024 |
| Mailing address | 108 W Market St, Bloomington, IL 61701-3918 |
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