Healthcare Provider Details

I. General information

NPI: 1831015411
Provider Name (Legal Business Name): WILLIAM DANIEL WALSH LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N HADDON AVE STE 3
HADDONFIELD NJ
08033-1703
US

IV. Provider business mailing address

501 N HADDON AVE STE 3
HADDONFIELD NJ
08033-1703
US

V. Phone/Fax

Practice location:
  • Phone: 856-428-7774
  • Fax:
Mailing address:
  • Phone: 856-428-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC000970900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: