Individual
JASON R WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW
Contact information
Practice address
4414 BENNING RD NE, WASHINGTON, DC 20019-4555
(202) 388-7759
Mailing address
4414 BENNING RD NE, WASHINGTON, DC 20019-4555
(202) 388-7759
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC50081298
DC
Other
Enumeration date
04/10/2018
Last updated
09/30/2019
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