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General NPI Number Information
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NPI Number | 1013088335
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Entity Type | Individual
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Provider Name | PEARLA DUNCAN WALL LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2784 N DECATUR RD STE 145
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City | DECATUR
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State | GA
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Zip | 30033-5903
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Country | US
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Telephone | 404-292-2664
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Fax | 404-292-2835
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Provider Business Mailing Address
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Address Line | 1105 WHITEHAWK TRL
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-7162
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Country | US
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Telephone | 770-277-9122
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Fax | 770-277-9122
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 000425
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License Number State | GA
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