NPI | 1710753835 |
---|---|
Other Name | LANAY DENIECE WALLS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 149.026493) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 21114) |
1041C0700X Social Worker, Clinical (Licence: IL 149.026493) | |
Enumeration Date | 2023-11-29 |
Last Update Date | 2024-08-19 |