Provider Demographics
NPI:1467096610
Name:WALLS, LISA RAE (LSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RAE
Last Name:WALLS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7446 BARRISTER DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7019
Mailing Address - Country:US
Mailing Address - Phone:740-201-6021
Mailing Address - Fax:
Practice Address - Street 1:7446 BARRISTER DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-7019
Practice Address - Country:US
Practice Address - Phone:740-201-6021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1101013104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker