Provider Demographics
NPI:1013088335
Name:WALL, PEARLA DUNCAN (LCSW)
Entity type:Individual
Prefix:
First Name:PEARLA
Middle Name:DUNCAN
Last Name:WALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1105 WHITEHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7162
Mailing Address - Country:US
Mailing Address - Phone:770-277-9122
Mailing Address - Fax:770-277-9122
Practice Address - Street 1:2784 N DECATUR RD
Practice Address - Street 2:STE 145
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5903
Practice Address - Country:US
Practice Address - Phone:404-292-2664
Practice Address - Fax:404-292-2835
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0004251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBBVXMedicare PIN