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Mrs. Susan D. Wallace, MA,LCDCS
Addiction (Substance Use Disorder) Counselor in Pawtucket, Rhode Island
NPI 1447375662

Susan D. Wallace is an Addiction (Substance Use Disorder) Counselor based in Pawtucket, RI and is specialized in Addiction (Substance Use Disorder). Susan D. Wallace practices in Pawtucket, RI and has the professional credentials of MA,LCDCS. The NPI Number for Susan D. Wallace is 1447375662 and holds a License No. LCDCS00022 (Rhode Island).

The current practice location address for Susan D. Wallace is 166 Pawtucket Avenue, Pawtucket, RI and can be reached out via phone at 401-722-4644 and via fax at 401-722-4867.

Location: 166 Pawtucket Avenue, Pawtucket, RI, 02860-3811
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1447375662
Provider Name
Susan D. Wallace
Credential
MA,LCDCS
Provider Entity Type
Individual
Gender
Female
Address
166 Pawtucket Avenue, Pawtucket, RI, 02860-3811
Phone Number
401-722-4644
Fax Number
401-722-4867
Provider Enumeration Date
03/20/2007
Last Update Date
11/16/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
62-43157 01 RI UNITED HEALTH
institution
Provider Business Practice Location Address Details
Address
166 Pawtucket Avenue
City
Pawtucket
State
Rhode Island
Zip
02860-3811
Phone Number
401-722-4644
Fax Number
401-722-4867
person
Provider Business Mailing Address Details
Address
166 Pawtucket Avenue
City
Pawtucket
State
Rhode Island
Zip
02860-3811
Phone Number
401-722-4644
Fax Number
401-722-4867
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
LCDCS00022 (Rhode Island)
Definition
Definition to come...
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