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General NPI Number Information
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NPI Number | 1891903530
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Entity Type | Individual
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Provider Name | SUZANNE WALLER L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 309 PIRKLE FERRY RD A 400
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City | CUMMING
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State | GA
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Zip | 30040-2545
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Country | US
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Telephone | 770-598-4034
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Fax | 706-865-0656
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Provider Business Mailing Address
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Address Line | PO BOX 999
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City | DAHLONEGA
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State | GA
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Zip | 30533-0017
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Country | US
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Telephone | 770-598-4034
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Fax | 706-865-0656
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC003440
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License Number State | GA
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