Provider Demographics
NPI:1184941940
Name:WALL, BRIAN KEITH (LPC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KEITH
Last Name:WALL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1213 CHIMNEY HILL DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6416
Mailing Address - Country:US
Mailing Address - Phone:919-896-4430
Mailing Address - Fax:919-000-0000
Practice Address - Street 1:3019 FALSTAFF RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1812
Practice Address - Country:US
Practice Address - Phone:919-250-7000
Practice Address - Fax:919-231-3231
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7369101YP2500X
SC8524101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional