Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | MH13715 | FL |
Y | 101YM0800X | Mental Health Counselor | MH13715 | FL |
N | 101YP1600X | Pastoral Counselor | 13715 | FL |
NPI | 1346613114 |
---|---|
Provider Name | Virginia Walls |
First Address | Pensacola, FL 32501-3306 |
Second Address | Pensacola, FL 32503-2671 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2015 |
Last Update Date | 23/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0KPZJ | FLORIDA BLUE (01) | FL |