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General NPI Number Information
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NPI Number | 1740626696
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Entity Type | Individual
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Provider Name | TINA WALLS LPC, LCADC
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Gender | Female
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 959 CENTRE RD
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City | WILMINGTON
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State | DE
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Zip | 19805-1268
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Country | US
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Telephone | 302-993-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 2318 HAMMOND PL KIRKWOOD GARDENS
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City | WILMINGTON
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State | DE
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Zip | 19808-4520
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Country | US
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Telephone | 302-528-8206
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00193700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC-0000633
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License Number State | DE
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