| Maria Wallace Rapid Transformational Therapist | |
|
345 Doucet Rd Ste 228 Lafayette LA 70503-3490 | |
| (337) 281-1121 | |
| Not Available |
| Full Name | Maria Wallace Rapid Transformational Therapist |
|---|---|
| Speciality | Social Worker |
| Location | 345 Doucet Rd Ste 228, Lafayette, Louisiana |
| Authorized Official Name and Position | Maxine Prevost (MANAGER) |
| Authorized Official Contact | 3372888929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maria Wallace Rapid Transformational Therapist 207 Waverly Blvd Lafayette LA 70508-8091 Ph: (337) 281-1121 | Maria Wallace Rapid Transformational Therapist 345 Doucet Rd Ste 228 Lafayette LA 70503-3490 Ph: (337) 281-1121 |
| NPI Number | 1982268728 |
|---|---|
| Provider Enumeration Date | 04/26/2019 |
| Last Update Date | 04/26/2019 |
| Medicare PECOS PAC ID | 9830427558 |
|---|---|
| Medicare Enrollment ID | O20190820000535 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982268728 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Maria H Wallace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508183831 PECOS PAC ID: 1658401542 Enrollment ID: I20100621000444 |
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