Provider Demographics
NPI:1477997757
Name:WALLS, CYNTHIA BRENNAN (LPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:BRENNAN
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 1:3081 N QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-4139
Mailing Address - Country:US
Mailing Address - Phone:202-256-5779
Mailing Address - Fax:
Practice Address - Street 1:124 E BROAD ST STE D
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4530
Practice Address - Country:US
Practice Address - Phone:703-534-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005433101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional