Individual
LISA NICOLE WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30045-8444
(770) 339-5377
(770) 339-5016
Mailing address
9239 SCARLETT DR SW, COVINGTON, GA 30014-2086
(678) 389-0755
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/17/2007
Last updated
10/17/2007
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