Provider Demographics
NPI:1174823983
Name:PRICE-WALLACE, DARCIE MARILYN (LCSW)
Entity Type:Individual
Prefix:
First Name:DARCIE
Middle Name:MARILYN
Last Name:PRICE-WALLACE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 OAK AVE APT 213
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4223
Mailing Address - Country:US
Mailing Address - Phone:773-988-5820
Mailing Address - Fax:
Practice Address - Street 1:3330 OLD GLENVIEW RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2963
Practice Address - Country:US
Practice Address - Phone:773-988-5820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0116651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical