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Brian Wallace
Addiction (Substance Use Disorder) Counselor in Upland, California
NPI 1437879418

Brian Wallace is an Addiction (Substance Use Disorder) Counselor based in San Bernardino, CA and is specialized in Addiction (Substance Use Disorder). Brian Wallace practices in Upland, CA. The NPI Number for Brian Wallace is 1437879418 and holds a License No. (California).

The current practice location address for Brian Wallace is 239 W 9Th St, Upland, CA and can be reached out via phone at 909-920-5102.

Location: 239 W 9Th St, Upland, CA, 92404-2439
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1437879418
Provider Name
Brian Wallace
Credential
Provider Entity Type
Individual
Gender
Male
Address
239 W 9Th St, Upland, CA, 92404-2439
Phone Number
909-920-5102
Fax Number
Provider Enumeration Date
08/31/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
239 W 9Th St
City
Upland
State
California
Zip
91786-5979
Phone Number
909-920-5102
Fax Number
person
Provider Business Mailing Address Details
Address
239 W 9Th St
City
Upland
State
California
Zip
91786-5979
Phone Number
909-920-5102
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
(California)
Definition
Definition to come...
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