Individual
DR. CHARLES CUTEZ WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
8221 WILLOW OAKS CORPORATE DR STE 4-425, FAIRFAX, VA 22031-4512
(703) 289-7560
(703) 289-4612
Mailing address
5605 CYPRESS CREEK DR APT 203, CHILLUM, MD 20782-3511
(504) 402-3601
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
0810008049
VA
Other
Enumeration date
06/25/2018
Last updated
08/24/2023
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