person
Charles Jerome Wallace, CASAC-T
Addiction (Substance Use Disorder) Counselor in New York, New York
NPI 1780125203

Charles Jerome Wallace is an Addiction (Substance Use Disorder) Counselor based in New York, NY and is specialized in Addiction (Substance Use Disorder). Charles Jerome Wallace practices in New York, NY and has the professional credentials of CASAC-T. The NPI Number for Charles Jerome Wallace is 1780125203 and holds a License No. (New York).

The current practice location address for Charles Jerome Wallace is 55 W 125Th St Fl 11, New York, NY and can be reached out via phone at 212-864-4128 and via fax at 212-662-9193.

Location: 55 W 125Th St Fl 11, New York, NY, 10027-4516
person
Provider Profile Details
NPI Number
1780125203
Provider Name
Charles Jerome Wallace
Credential
CASAC-T
Provider Entity Type
Individual
Gender
Male
Address
55 W 125Th St Fl 11, New York, NY, 10027-4516
Phone Number
212-864-4128
Fax Number
212-662-9193
Provider Enumeration Date
03/16/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
55 W 125Th St Fl 11
City
State
Zip
10027-4516
Phone Number
212-864-4128
Fax Number
212-662-9193
person
Provider Business Mailing Address Details
Address
55 W 125Th St Fl 11
City
State
Zip
10027-4516
Phone Number
212-864-4128
Fax Number
212-662-9193
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
(New York)
Definition
Definition to come...
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