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NPI Code Detail

MEDICARE: MS. TINA WALLS LPC, LCADC

MEDICARE: MS. TINA WALLS LPC, LCADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor37LC00193700NJ
2101YP2500XProfessional CounselorPC-0000633DE

General Provider Information

NPI Number : 1740626696
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TINA WALLS LPC, LCADC
Provider Business Mailing Address
First Line : 2318 HAMMOND PL
Second Line : KIRKWOOD GARDENS
City : WILMINGTON
State : DE
Zip : 19808-4520
Country : US
Telephone Number : 302-528-8206
Fax Number :
Provider Business Practice Location Address
First Line : 959 CENTRE RD
Second Line :
City : WILMINGTON
State : DE
Zip : 19805-1268
Country : US
Telephone Number : 302-993-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2013
Last Update Date : 05/20/2013

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