IndividualActive
Alicia Wallace
NPI 1114746765 · Mental Health Counselor · Bloomington, IL
Provider details
- NPI number
- 1114746765
- Entity type
- Individual
- Primary specialty
- Mental Health CounselorBehavioral Health & Social Service Providers
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
Behavioral Health & Social Service Providers
Practice location
108 W Market St
Bloomington, IL 61701-3918
Phone: (309) 827-5351
Fax: (309) 829-6808
Approximate (ZIP-level) locationGet directions
Mailing address
108 W Market St
Bloomington, IL 61701-3918
Registry dates
- Enumerated
- 2024-10-09
- Last updated
- 2024-10-09
- Certified
- 2024-10-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.