Provider Demographics
NPI:1598055584
Name:MARIEA, DOLORES WALLING (LPCC)
Entity Type:Individual
Prefix:MS
First Name:DOLORES
Middle Name:WALLING
Last Name:MARIEA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MS
Other - First Name:D. WALLING
Other - Middle Name:DOLORES
Other - Last Name:MARIEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6501 FALLEN TIMBERS LANE
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537
Mailing Address - Country:US
Mailing Address - Phone:419-893-6218
Mailing Address - Fax:
Practice Address - Street 1:6501 FALLEN TIMBERS LANE
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:419-893-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0000301102X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist