Provider Demographics
NPI:1245933720
Name:WALL, AYANA (MS)
Entity type:Individual
Prefix:MS
First Name:AYANA
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N RADNOR CHESTER RD STE F200
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5245
Mailing Address - Country:US
Mailing Address - Phone:610-977-2417
Mailing Address - Fax:610-977-0043
Practice Address - Street 1:150 N RADNOR CHESTER RD STE F200
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5245
Practice Address - Country:US
Practice Address - Phone:610-977-2417
Practice Address - Fax:610-977-0043
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty