Most Relevant Information
Provider Data
| NPI Number: | 1003382938 |
| Provider Name: | EDWINA WALLACE |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 6401011732 |
Most Important Dates
| Enumeration Date: | 10/18/2018 |
| Last Updated: | 10/18/2018 |
Provider Practice Location
140 MICHIGAN AVE W
BATTLE CREEK
MI
490173602
Practice Location Phone/Fax
| Phone: | 2699661460 |
| Fax: | 2699662844 |
Provider Mailing Location
140 MICHIGAN AVE W
BATTLE CREEK
MI
490173602
Provider Mailing Phone/Fax
| Phone: | 2699661460 |
| Fax: | 2699662844 |