Shanthalitta Wallace's National Provider Identifier (NPI) Details
Shanthalitta Wallace, LMHC
NPI: 1659848539
Enumeration Date: 2018-10-29
Last updated: 2018-10-29
Sole Proprietor: YES
Status: active
Postal Address: 9617 WATERSHED DR E, JACKSONVILLE, FL
Phone: 860-496-0909
Primary Practice Address: 9617 WATERSHED DR E, JACKSONVILLE, FL
Practice's phone: