Individual
THEODORE EDWIN WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., LMHC, LPC
Contact information
Practice address
54 HARRIS PL STE 105, BRATTLEBORO, VT 05301-6709
(802) 451-0314
(877) 532-0268
Mailing address
228 STEADY LN, ASHFIELD, MA 01330-9724
(413) 345-8745
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
068.0067951
VT
101YM0800X
Mental Health Counselor
8227
MA
101YP2500X
Professional Counselor
16743
TX
Other
Enumeration date
04/02/2007
Last updated
06/18/2022
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