Individual provider · Type 1 NPI

Mary Etheridge Wallace, LPC

Professional Counselor · Elizabeth City, NC

NPI number 1801136809 Active

Practice location

303 E. Main Street Suite 9
Elizabeth City, NC 27909

Call (252) 619-6629 Map

Fax (252) 331-2499

Other practice locations

  • 281 Independence Blvd, Suite 326, Virginia Beach, VA 23462-2986 · (757) 490-0377

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor 101YP2500X0701005385 (VA)
Professional Counselor Primary 101YP2500X12837 (NC)

Professional Counselor: Definition to come...

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About NPI 1801136809

Mary Etheridge Wallace, LPC's National Provider Identifier is 1801136809, issued on Feb 27, 2013. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Elizabeth City, NC. The record was last updated on Sep 6, 2018.