Individual
RONALD WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
5900 FORT DR STE 207, CENTREVILLE, VA 20121-2425
(703) 659-1292
(703) 659-9607
Mailing address
5900 FORT DR STE 207, CENTREVILLE, VA 20121-2425
(703) 659-1292
(703) 659-9607
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0001152470
VA
Other
Enumeration date
01/03/2017
Last updated
01/03/2017
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