Provider Demographics
NPI:1568887826
Name:WALL, DIANA JANEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:JANEL
Last Name:WALL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 P ST NW
Mailing Address - Street 2:SUITE 740
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5915
Mailing Address - Country:US
Mailing Address - Phone:301-437-1785
Mailing Address - Fax:
Practice Address - Street 1:2000 P ST NW
Practice Address - Street 2:SUITE 740
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5915
Practice Address - Country:US
Practice Address - Phone:301-437-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY10008103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic