Individual
CHARLAYNE WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
1819 W HAVENWOOD AVE, NAMPA, ID 83651-5003
(208) 615-3956
Mailing address
1819 W HAVENWOOD AVE, NAMPA, ID 83651-5003
(208) 369-0092
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC5560
ID
Other
Enumeration date
10/05/2010
Last updated
08/31/2014
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