Provider Demographics
NPI:1619744976
Name:WALLS, CAITLIN R (LPCMH, LAAT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:R
Last Name:WALLS
Suffix:
Gender:F
Credentials:LPCMH, LAAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-3403
Mailing Address - Country:US
Mailing Address - Phone:302-576-8080
Mailing Address - Fax:302-576-8084
Practice Address - Street 1:401 E 12TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-3403
Practice Address - Country:US
Practice Address - Phone:302-576-8080
Practice Address - Fax:302-576-8084
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011332101YM0800X
DEAS-0010001221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist