Provider Demographics
NPI:1154384733
Name:WALL, DAVID ROY (MSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ROY
Last Name:WALL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 CHARTWELL DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-7751
Mailing Address - Country:US
Mailing Address - Phone:757-722-9961
Mailing Address - Fax:757-726-6035
Practice Address - Street 1:100 EMANCIPATION DR
Practice Address - Street 2:VETERANS AFFAIRS MEDICAL CENTER
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-0001
Practice Address - Country:US
Practice Address - Phone:757-722-9961
Practice Address - Fax:757-726-6035
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3004451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical