Wallace, Jerron

Wallace, Jerron is an sole proprietor health care provider with primary practice located at 912 1St St Nw , Albuquerque NM 87102-2355. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Wallace, Jerron can be contacted via phone (505) 224-9777.

Contact Information

Primary practice address
912 1St St Nw Albuquerque NM 87102-2355
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X X-09336 New Mexico

Profile Details

NPI number 1033589247
LBN Legal business name Wallace, Jerron
Credentials LMSW
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 30th, 2015
Last updated Jan 19th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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