person
Dedra Wallace
Professional Counselor in Pueblo, Colorado
NPI 1063810877

Dedra Wallace is a Professional Counselor based in Pueblo, CO and is specialized in Professional. Dedra Wallace practices in Pueblo, CO. The NPI Number for Dedra Wallace is 1063810877 and holds a License No. LPC.0013214 (Colorado).

The current practice location address for Dedra Wallace is 1302 Chinook Ln, Pueblo, CO and can be reached out via phone at 719-545-2746 and via fax at 719-545-4100. You can also correspond with Dedra Wallace through the mailing address at 41 MONTEBELLO ROAD, PUEBLO, CO - 81004-1128 (mailing address contact number: 719-545-2746).

Location: 1302 Chinook Ln, Pueblo, CO, 81004-1128
person
Provider Profile Details
NPI Number
1063810877
Provider Name
Dedra Wallace
Credential
Provider Entity Type
Individual
Gender
Female
Address
1302 Chinook Ln, Pueblo, CO, 81004-1128
Phone Number
719-545-2746
Fax Number
719-545-4100
Provider Enumeration Date
12/10/2014
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1302 Chinook Ln
City
State
Zip
81001-1851
Phone Number
719-545-2746
Fax Number
719-545-4100
person
Provider Business Mailing Address Details
Address
1302 Chinook Ln
City
State
Zip
81001-1851
Phone Number
719-545-2746
Fax Number
719-545-4100
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
LPC.0013214 (Colorado)
Definition
Definition to come...
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