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NPI Code Detail

MEDICARE: TESSA WALLS LCPC

MEDICARE: TESSA WALLS LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLC16481MD

General Provider Information

NPI Number : 1255967576
Entity Type Code : Individual
Provider Name (Legal Business Name) : TESSA WALLS LCPC
Provider Business Mailing Address
First Line : 14513 FINCH LN
Second Line :
City : HANCOCK
State : MD
Zip : 21750-1703
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20 W WASHINGTON ST STE 503
Second Line :
City : HAGERSTOWN
State : MD
Zip : 21740-4520
Country : US
Telephone Number : 410-861-0175
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2020
Last Update Date : 10/09/2025

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