Provider Demographics
NPI:1770296840
Name:WALLNER, DARRIS MICHAEL (LPC)
Entity type:Individual
Prefix:
First Name:DARRIS
Middle Name:MICHAEL
Last Name:WALLNER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MILL RACE DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-6933
Mailing Address - Country:US
Mailing Address - Phone:301-481-4804
Mailing Address - Fax:
Practice Address - Street 1:333 W CORK ST UNIT 35
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3897
Practice Address - Country:US
Practice Address - Phone:540-431-5909
Practice Address - Fax:540-431-5366
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health