Individual provider · Type 1 NPI

Charles Jerome Wallace, CASAC-T

Addiction (Substance Use Disorder) Counselor · New York, NY

NPI number 1780125203 Active

Practice location

55 W 125th St Fl 11
New York, NY 10027-4516

Call (212) 864-4128 Map

Fax (212) 662-9193

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XNone listed

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1780125203

Charles Jerome Wallace, CASAC-T's National Provider Identifier is 1780125203, issued on Mar 16, 2017. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in New York, NY. The record was last updated on Mar 16, 2017.