Individual
LYNDA SMITH WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
931 CASSAT AVE, JACKSONVILLE, FL 32205-4857
(904) 388-2828
(904) 388-2821
Mailing address
13018 VIBURNUM DR N, JACKSONVILLE, FL 32246-1144
(904) 992-8942
(904) 731-0085
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
455
AL
103TC0700X
Clinical Psychologist
Primary
PY 4887
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
455
LICENSE NUMER
AL
01
—
PY4887
LICENSE NUMBER
FL
Enumeration date
09/20/2006
Last updated
07/08/2007
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