Provider Demographics
NPI:1194733931
Name:WALLER, JAMES FRANKLIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:FRANKLIN
Last Name:WALLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1201 TIMBERLAND DR SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-2119
Mailing Address - Country:US
Mailing Address - Phone:256-355-6679
Mailing Address - Fax:256-460-0030
Practice Address - Street 1:8075 MADISON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2041
Practice Address - Country:US
Practice Address - Phone:256-772-6220
Practice Address - Fax:256-460-0030
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0241C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical