Provider Demographics
NPI:1992326458
Name:WALL, JOSEPH CHARLES PRESTON (LPC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CHARLES PRESTON
Last Name:WALL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-1723
Mailing Address - Country:US
Mailing Address - Phone:240-818-9436
Mailing Address - Fax:
Practice Address - Street 1:1000 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-1723
Practice Address - Country:US
Practice Address - Phone:434-528-3263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012361101YP2500X
VA0701009220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional