Individual
ANDREW R WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
180008228
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
180008228
IL
101YM0800X
Mental Health Counselor
180008228
IL
101YP2500X
Professional Counselor
Primary
180008228
IL
Other
Enumeration date
08/03/2012
Last updated
10/02/2014
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