Provider Demographics
NPI:1245962067
Name:WALL, DEANNA (LCSW, C-SSWS)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:LCSW, C-SSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5944 RIVERBEND LAKES DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70820-5046
Mailing Address - Country:US
Mailing Address - Phone:225-278-6737
Mailing Address - Fax:
Practice Address - Street 1:5944 RIVERBEND LAKES DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820-5046
Practice Address - Country:US
Practice Address - Phone:225-278-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA52451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical