| Doctor Name: | CHRISTINE MARIE WALLACE |
| NPI Number: | 1053586842 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 95 Pleasant St Lynn, MA - 019011524 |
| Business Phone Number: | 7815814454 |
| Business Fax Number: | |
| Mailing Address: | 75 Eidelweiss Dr, MADISON |
| State: | NH |
| Postal Code: | 038495638 |
| Phone Number: | 6033679441 |
| Fax Number: | |
| NPI Enumeration Date: | 04/23/2008 |
| NPI Last Update Date: | 04/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |