Individual
DONALD E. WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
431 N STATE ST, JACKSON, MS 39201-1108
(601) 949-1949
Mailing address
4651 TRAWICK DR, JACKSON, MS 39211-5835
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1497
MS
Other
Enumeration date
11/23/2010
Last updated
11/23/2010
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