Provider Demographics
NPI:1972272961
Name:WALLER, JULIANNA ROSE (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:ROSE
Last Name:WALLER
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4697 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-1338
Mailing Address - Country:US
Mailing Address - Phone:740-968-7006
Mailing Address - Fax:
Practice Address - Street 1:146 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1225
Practice Address - Country:US
Practice Address - Phone:304-905-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2308693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health