Provider Demographics
NPI:1518586411
Name:DASHAWN WALLACE COUNSELING, LLC
Entity Type:Organization
Organization Name:DASHAWN WALLACE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DASHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:313-655-4271
Mailing Address - Street 1:32489 ORIOLE LN
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2564
Mailing Address - Country:US
Mailing Address - Phone:313-655-4271
Mailing Address - Fax:
Practice Address - Street 1:13 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2617
Practice Address - Country:US
Practice Address - Phone:734-999-0138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty