Individual
MARY WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., LPC, NCC
Contact information
Practice address
10985 N HARRELLS FERRY RD, 2ND FLOOR, BATON ROUGE, LA 70816-8362
(225) 485-7005
Mailing address
10985 N HARRELLS FERRY RD, 2ND FLOOR, BATON ROUGE, LA 70816-8362
(225) 485-7005
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4584
LA
Other
Enumeration date
06/08/2016
Last updated
06/08/2016
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