Individual provider · Type 1 NPI
Formecia Wallace, MS, MA, LCAS-A
Addiction (Substance Use Disorder) Counselor · Williamston, NC
NPI number
1518423045
Active
Practice location
618 E Boulevard
Williamston, NC 27892-2736
Fax (252) 792-0660
Mailing address
1070 Wynn Rd
Williamston, NC 27892-8844
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | 25169 (NC) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
Another provider at this address
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About NPI 1518423045
Formecia Wallace, MS, MA, LCAS-A's National Provider Identifier is 1518423045, issued on Feb 20, 2019. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Williamston, NC. The record was last updated on Mar 5, 2019.