Provider Demographics
NPI:1316511181
Name:WALLING, ELIZABETH (LGSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WALLING
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 HIGH ST STE 816
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5448
Mailing Address - Country:US
Mailing Address - Phone:304-288-3504
Mailing Address - Fax:304-777-4487
Practice Address - Street 1:235 HIGH ST STE 816
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5448
Practice Address - Country:US
Practice Address - Phone:304-288-3504
Practice Address - Fax:304-777-4487
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009459111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical