| Doctor Name: | MR. MARK ALLEN WALLMAN |
| NPI Number: | 1164676029 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.P.C., L.C.A.D.C. |
| License Number: | 37LC00156700 |
| Business Practice Address: | 314 Kelly Ln Boonton, NJ - 070052110 |
| Business Phone Number: | 9733346006 |
| Business Fax Number: | |
| Mailing Address: | 314 Kelly Ln, BOONTON |
| State: | NJ |
| Postal Code: | 070052110 |
| Phone Number: | 9733346006 |
| Fax Number: | |
| NPI Enumeration Date: | 11/05/2008 |
| NPI Last Update Date: | 05/06/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 37LC00156700 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |