Individual
FALLON VICTORIA WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
610 E 7TH ST, CHARLOTTE, NC 28202-2923
(980) 474-1716
Mailing address
707 REGENCY DR, CHARLOTTE, NC 28211-5418
(704) 591-2019
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A12803
NC
Other
Enumeration date
08/28/2017
Last updated
08/28/2017
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