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General NPI Number Information
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NPI Number | 1194958769
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Entity Type | Organization
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Legal Business Name | WALES COUNSELING CENTER, PLLC
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 2000 E LAMAR BLVD SUITE 600
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City | ARLINGTON
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State | TX
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Zip | 76006-7346
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Country | US
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Telephone | 214-519-9473
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 E LAMAR BLVD SUITE 600
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City | ARLINGTON
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State | TX
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Zip | 76006-7346
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Country | US
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Telephone | 214-519-9473
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. SEDRICK WALES JACKSON
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Credential | LCSW
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Telephone | 214-519-9473
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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 | 41529
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License Number State | TX
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