Provider Demographics
NPI:1437328960
Name:WALLS, SANDRA K (LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:WALLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1815 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:1507 E. RACE ST.
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4661
Practice Address - Country:US
Practice Address - Phone:501-305-2359
Practice Address - Fax:501-305-2348
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
ARP0801004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A827OtherBCBS
AR172638795Medicaid