Individual
AMANDA WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
154 WAYPOINT DR, EATONTOWN, NJ 07724-2184
(908) 310-7788
Mailing address
409 SOUTH STREET PO BOX 1111, EATONTOWN, NJ 07724-4111
(908) 310-7788
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
37PC00637200
NJ
Other
Enumeration date
08/25/2020
Last updated
12/09/2022
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