Individual
MELISSA CAROL WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
900 BEASLEY ST, STE. 120, LEXINGTON, KY 40509-4266
(859) 245-1035
Mailing address
900 BEASLEY ST, STE. 120, LEXINGTON, KY 40509-4266
(859) 245-1035
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4095
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100363400
—
KY
Enumeration date
09/18/2014
Last updated
10/16/2015
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