Individual provider · Type 1 NPI

Keyonna Wallace

Addiction (Substance Use Disorder) Counselor · Kew Gardens, NY

NPI number 1861032864 Active

Practice location

8002 Kew Gardens Rd Ste 704
Kew Gardens, NY 11415-3607

Call (718) 520-1513 Map

Mailing address

79 Glenridge Rd
Glenville, NY 12302-4523

Other practice locations

  • 135 W 50th St, New York, NY 10020-1201 · (212) 582-9100

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400X31387 (NY)

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

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About NPI 1861032864

Keyonna Wallace's National Provider Identifier is 1861032864, issued on Jan 8, 2020. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Kew Gardens, NY. The record was last updated on Oct 19, 2020.