Healthcare Provider Details

I. General information

NPI: 1962542746
Provider Name (Legal Business Name): DANA DORIANE WALLS B.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 SHELBY OAKS DR
MEMPHIS TN
38134-7316
US

IV. Provider business mailing address

664 WEST ST
HOLLY SPRINGS MS
38635-1602
US

V. Phone/Fax

Practice location:
  • Phone: 901-252-1281
  • Fax: 901-252-7680
Mailing address:
  • Phone: 901-309-6845
  • Fax: 901-252-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: