Wallace, Connie Lee

Wallace, Connie Lee is an sole proprietor health care provider with primary practice located at 547 1/2 S James St Ste. A, Dover OH 44622-2137. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Wallace, Connie Lee can be contacted via phone (330) 343-7400.

Contact Information

Primary practice address
547 1/2 S James St Ste. A Dover OH 44622-2137
Phone: (330) 343-7400
Fax: (330) 343-7414
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X E0001636-SUPV Ohio
Behavioral Health & Social Service Providers / Professional 101YP2500X E0001636-SUPV Ohio

Profile Details

NPI number 1386668200
LBN Legal business name Wallace, Connie Lee
Credentials LPCC-S, CTT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 26th, 2006
Last updated Feb 16th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386668200 NPPES
Ohio MEDICAID 741212

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