Individual provider · Type 1 NPI

Deeandriez Wallace

Mental Health Counselor · Shreveport, LA

NPI number 1669113239 Active

Practice location

3003 Knight St, Suite 115
Shreveport, LA 71105-2561

Call (318) 614-7314 Map

Mailing address

3003 Knight St Ste 115
Shreveport, LA 71105-2561

Specialties and licenses

Taxonomy	Code	License
Case Manager/Care Coordinator	171M00000X	None listed
Mental Health Counselor Primary	101YM0800X	PLC9016 (LA)

Mental Health Counselor: Definition to come...

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About NPI 1669113239

Deeandriez Wallace's National Provider Identifier is 1669113239, issued on Apr 6, 2022. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Shreveport, LA. The record was last updated on Feb 3, 2023.