| Doctor Name: | TARKISHA WALLACE |
| NPI Number: | 1407233505 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC-S, NCC |
| License Number: | 4405 |
| Business Practice Address: | 7028 Silver Springs Dr Greenwell Springs, LA - 707394030 |
| Business Phone Number: | 2259318857 |
| Business Fax Number: | |
| Mailing Address: | 7028 Silver Springs Dr, GREENWELL SPRINGS |
| State: | LA |
| Postal Code: | 707394030 |
| Phone Number: | 2259318857 |
| Fax Number: | |
| NPI Enumeration Date: | 04/28/2015 |
| NPI Last Update Date: | 04/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 4405 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |