Provider Demographics
NPI:1710753835
Name:WALLS, LANAY DENIECE (LCSW)
Entity Type:Individual
Prefix:
First Name:LANAY
Middle Name:DENIECE
Last Name:WALLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LANAY
Other - Middle Name:DENIECE
Other - Last Name:WALLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1200 E 78TH ST APT 205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-3372
Mailing Address - Country:US
Mailing Address - Phone:773-485-9597
Mailing Address - Fax:773-359-4521
Practice Address - Street 1:1200 E 78TH ST APT 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-3372
Practice Address - Country:US
Practice Address - Phone:773-485-9597
Practice Address - Fax:773-359-4521
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21114101YA0400X
IL149.0264931041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health