Provider Demographics
NPI:1154040954
Name:WALLACE, ANNA LEESE (LCMHCA)
Entity type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:LEESE
Last Name:WALLACE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:MISS
Other - First Name:ANNA LEESE
Other - Middle Name:
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMHCA
Mailing Address - Street 1:15 CASTLEKNOCK DR APT 205
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-4564
Mailing Address - Country:US
Mailing Address - Phone:864-915-8286
Mailing Address - Fax:
Practice Address - Street 1:30 GARFIELD ST STE A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-7301
Practice Address - Country:US
Practice Address - Phone:888-651-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17911101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor