Individual
ROBERT ANDREW DE WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
444 HOSPITAL WAY STE 477, POCATELLO, ID 83201-2744
(208) 233-7832
(208) 233-7835
Mailing address
65 FORDHAM ST, POCATELLO, ID 83201-3418
(208) 317-0027
(208) 234-2800
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC-4672
ID
Other
Enumeration date
11/04/2010
Last updated
10/22/2021
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