MEDICARE: DEBBIE ANN WALL A.A., B.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942513536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE ANN WALL A.A., B.A.

Provider Business Mailing Address
First Line	:	1041 REDONDO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3928
Country	:	US
Telephone Number	:	562-987-5722
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 E 7TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-4931
Country	:	US
Telephone Number	:	562-987-5722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2010
Last Update Date	:	07/23/2010

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