Provider Demographics
NPI:1659548741
Name:WALLER, ANNE MCCAULEY (LCSW-C, MSW)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MCCAULEY
Last Name:WALLER
Suffix:
Gender:F
Credentials:LCSW-C, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 LINDEN CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1127
Mailing Address - Country:US
Mailing Address - Phone:410-718-2229
Mailing Address - Fax:
Practice Address - Street 1:5074 DORSEY HALL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7792
Practice Address - Country:US
Practice Address - Phone:410-718-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD080941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical