Charles L Wallace, LADAC is an addiction (substance use disorder) counselor in Farmington, NM. Charles L Wallace, LADAC NPI is 1902140932. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
2901 E. 20TH SUITE 104
FARMINGTON, NM
ZIP 87499
Phone: (505) 326-0241
Fax: (505) 325-8356
The enumeration date for this NPI number is 11/15/2012 and was last updated on 11/15/2012.