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General NPI Number Information
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NPI Number | 1063754877
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Entity Type | Organization
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Legal Business Name | DENISE C. WALL, LCSW LLC
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 610 MAIN ST
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City | ODESSA
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State | DE
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Zip | 19730-2012
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Country | US
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Telephone | 302-376-5259
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Fax | 302-689-4474
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Provider Business Mailing Address
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Address Line | PO BOX 514
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City | ODESSA
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State | DE
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Zip | 19730-0514
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Country | US
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Telephone | 302-376-5259
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Fax | 302-689-4474
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Authorized Official
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Title or Position | PSYCHO THERAPIST
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Name | MS. DENISE CECILIA WALL
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Credential | LCSW
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Telephone | 302-376-5259
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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 | Q1-0000304
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License Number State | DE
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