Wallace, Stephen James

Wallace, Stephen James is an individual health care provider with primary practice located at 625 Cleveland Ave Nw , Canton OH 44702-1805. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Wallace, Stephen James can be contacted via phone (330) 453-8252.

Contact Information

Primary practice address
625 Cleveland Ave Nw Canton OH 44702-1805
Phone: (330) 453-8252
Fax: (330) 453-6716
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X E.1000187 Ohio

Profile Details

NPI number 1023399052
LBN Legal business name Wallace, Stephen James
Credentials LPCC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 3rd, 2011
Last updated Mar 2nd, 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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Identifiers

StateTypeNumberIssuer
All States NPI 1023399052 NPPES
Ohio MEDICAID 0168101

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