Charles Jerome Wallace, CASAC-T
Charles Jerome Wallace, CASAC-T is an Addiction (Substance Use Disorder) Counselor in New York, New York. Practices as a sole proprietor. Licensed in New York.
- Licensed in
- NY
- In the registry since
- 2017
Practice location Address checks out
55 W 125th St Fl 11New York, NY 10027-4516
Phone: (212) 864-4128
Fax: (212) 662-9193
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Specialties & licences
| Addiction (Substance Use Disorder) Counselor (primary) | Taxonomy 101YA0400X (NY) |
|---|
Record details
| NPI number | 1780125203 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | CASAC-T |
| Sole proprietor | Yes |
| NPI enumerated | March 16, 2017 |
| Last updated in NPPES | March 16, 2017 |
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