| Doctor Name: | DEAVEN MCGUIRE WALLACE |
| NPI Number: | 1033378294 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LPC |
| License Number: | 0701004377 |
| Business Practice Address: | 21731 Timberlake Rd Lynchburg, VA - 245027400 |
| Business Phone Number: | 4344555033 |
| Business Fax Number: | 4344555034 |
| Mailing Address: | 21731 Timberlake Rd, LYNCHBURG |
| State: | VA |
| Postal Code: | 245027400 |
| Phone Number: | 4344555033 |
| Fax Number: | 4344555034 |
| NPI Enumeration Date: | 06/03/2008 |
| NPI Last Update Date: | 06/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 0701004377 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |