Provider Demographics
NPI:1427483379
Name:WALLACE, YOLANDA L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:L
Last Name:WALLACE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:YOLANDA
Other - Middle Name:L
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:406 PECAN
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72342-3212
Mailing Address - Country:US
Mailing Address - Phone:870-338-8447
Mailing Address - Fax:870-338-8048
Practice Address - Street 1:406 PECAN
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-3212
Practice Address - Country:US
Practice Address - Phone:870-338-8447
Practice Address - Fax:870-338-8048
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7520-M104100000X
AR7520-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker