Individual provider · Type 1 NPI

Jennifer Dawn Wallace, LPCC/S

Professional Counselor · Georgetown, KY

NPI number 1174158976 Active

Practice location

204 Bevins Ln Ste A
Georgetown, KY 40324-6145

Call (859) 951-9777 Map

Fax (859) 951-9779

Other practice locations

  • 200 Bevins Ln Ste E, Georgetown, KY 40324-8532 · (859) 951-9777

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor Primary 101YP2500X104157
Counselor 101Y00000X104157 (KY)

Professional Counselor: Definition to come...

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About NPI 1174158976

Jennifer Dawn Wallace, LPCC/S's National Provider Identifier is 1174158976, issued on Mar 12, 2020. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Georgetown, KY. The record was last updated on Nov 20, 2020.