Provider Demographics
NPI:1750513479
Name:WALLS, LISA ALINE LOVGREN (P-LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ALINE LOVGREN
Last Name:WALLS
Suffix:
Gender:F
Credentials:P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 LAWYERS STATION RD
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-1403
Mailing Address - Country:US
Mailing Address - Phone:704-400-8628
Mailing Address - Fax:
Practice Address - Street 1:516 W INNES ST STE 6
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4276
Practice Address - Country:US
Practice Address - Phone:704-756-6877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP005076104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker