Individual
MICHAEL WAYNE WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
784 W LEBANON ST, MOUNT AIRY, NC 27030-2218
(336) 293-3603
Mailing address
PO BOX 607, TOAST, NC 27049-0607
(336) 293-3603
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3233
NC
Other
Enumeration date
04/28/2010
Last updated
04/28/2010
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