Individual
CHARLOTTE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
4001 JOHN STREET, EVANSVILLE, IN 47714-0247
(812) 473-3144
(812) 422-7558
Mailing address
415 MULBERRY STREET, EVANSVILLE, IN 47713-1230
(812) 423-7791
(812) 422-7558
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39000523A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100240880
—
IN
Enumeration date
09/26/2008
Last updated
04/21/2010
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