Individual ProviderDonna WallaceCounselorBehavioral Health & Social Service ProvidersPractice Address2814 S Us Highway 1, Suite D-4, Fort Pierce, FL 34982-8120(772) 501-3057PECOS EnrollmentBased on the most recent information from CMS, provider Donna Wallace does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1639558471Provider TypeIndividualFull NameWallace, DonnaGenderFemaleSole ProprietorYesEnumeration Date5/26/2015Last Updated3/19/2019Contact InformationPractice LocationPractice Address2814 S Us Highway 1, Suite D-4, Fort Pierce, FL 34982-8120Phone(772) 501-3057FaxUnlisted FaxMailing LocationMailing Address567 NW Lake Whitney Pl Ste 101, Port St Lucie, FL 34986-1629PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer