Individual
GINA THARA WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
17601 JAMES WAY, EAGLE RIVER, AK 99577-9254
(907) 854-2344
Mailing address
17601 JAMES WAY, EAGLE RIVER, AK 99577-9254
(907) 854-2344
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
159747
AK
Other
Enumeration date
07/17/2020
Last updated
07/17/2020
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