Provider Demographics
NPI:1093861502
Name:WALLS, WILLIAM R (LCSW C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:WALLS
Suffix:
Gender:M
Credentials:LCSW C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WINTERS LANE
Mailing Address - Street 2:THE RENAISSANCE CENTER
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-747-3360
Mailing Address - Fax:410-747-3364
Practice Address - Street 1:10 WINTERS LANE
Practice Address - Street 2:THE RENAISSANCE CENTER
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-747-3360
Practice Address - Fax:410-747-3364
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11482104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker