Provider Demographics
NPI:1770920811
Name:WALLIO, ROSEMARY WISEMAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:WISEMAN
Last Name:WALLIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1503 POSSUM QUARTER RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9390
Mailing Address - Country:US
Mailing Address - Phone:252-312-3556
Mailing Address - Fax:252-331-0320
Practice Address - Street 1:905 HALSTEAD BLVD STE 21
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6816
Practice Address - Country:US
Practice Address - Phone:252-331-0322
Practice Address - Fax:252-331-0320
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0016211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical