Provider Demographics
NPI:1275760142
Name:WALLS, BRIDGET W (LPC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:W
Last Name:WALLS
Suffix:
Gender:F
Credentials:LPC
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 968
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-0968
Mailing Address - Country:US
Mailing Address - Phone:828-689-4850
Mailing Address - Fax:828-689-4850
Practice Address - Street 1:5335 E FORK RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-7119
Practice Address - Country:US
Practice Address - Phone:828-206-0810
Practice Address - Fax:828-206-0810
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3463101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional