Provider Demographics
NPI:1235268798
Name:WALLS, DWIGHT A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:A
Last Name:WALLS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344
Mailing Address - Country:US
Mailing Address - Phone:731-986-2213
Mailing Address - Fax:731-986-0011
Practice Address - Street 1:600 RB WILSON DR
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-1726
Practice Address - Country:US
Practice Address - Phone:731-986-2213
Practice Address - Fax:731-986-0011
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000046741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical