Individual
MRS. DEMETRIA S WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
5345 HIGHWAY 18 W, JACKSON, MS 39209-9421
(601) 927-0188
(601) 292-7998
Mailing address
PO BOX 2305, CLINTON, MS 39060-2305
(601) 927-0188
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M8329
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003469743
—
MS
Enumeration date
07/09/2021
Last updated
05/08/2023
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