| Doctor Name: | MRS. SHANNON MCNALLY WALLACE |
| NPI Number: | 1326290982 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LCSW |
| License Number: | C006865 |
| Business Practice Address: | 102 Agate Ct Knightdale, NC - 275457879 |
| Business Phone Number: | 9198333111 |
| Business Fax Number: | 9194450405 |
| Mailing Address: | 102 Agate Ct, KNIGHTDALE |
| State: | NC |
| Postal Code: | 275457879 |
| Phone Number: | 9194144315 |
| Fax Number: | 9194450405 |
| NPI Enumeration Date: | 10/15/2008 |
| NPI Last Update Date: | 01/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | C006865 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |