Provider Demographics
NPI:1326258534
Name:BARBER-WALLACE, ELLEN E (MS)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:E
Last Name:BARBER-WALLACE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FECHET DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-6159
Mailing Address - Country:US
Mailing Address - Phone:228-374-1152
Mailing Address - Fax:
Practice Address - Street 1:2020 HARDY ST
Practice Address - Street 2:SUITE 2-A
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-4941
Practice Address - Country:US
Practice Address - Phone:601-544-8556
Practice Address - Fax:601-544-8867
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor