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General NPI Number Information
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NPI Number | 1821768342
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Entity Type | Individual
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Provider Name | CARLA A. WALL PHD LCP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 2924 BROOK RD
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City | RICHMOND
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State | VA
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Zip | 23220-1215
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Country | US
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Telephone | 804-828-2467
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Fax | 804-628-1236
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Provider Business Mailing Address
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Address Line | PO BOX 780125
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City | PHILADELPHIA
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State | PA
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Zip | 19178-0125
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Country | US
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Telephone | 804-922-4844
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810008301
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License Number State | VA
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