Individual provider · Type 1 NPI

Bonita Lucille Wallace, LPC

Professional Counselor · Atlanta, GA

NPI number 1912364787 Active

Practice location

550 Pharr Rd NE, Suite 605
Atlanta, GA 30305-3428

Call (404) 664-6398 Map

Fax (678) 705-2758

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor Primary 101YP2500X1823 (GA)

Professional Counselor: Definition to come...

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About NPI 1912364787

Bonita Lucille Wallace, LPC's National Provider Identifier is 1912364787, issued on Jan 25, 2016. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Atlanta, GA. The record was last updated on Jan 25, 2016.