Provider Demographics
NPI:1902540586
Name:WALLS, CHELSEA DESIREE (LCMHC-A)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:DESIREE
Last Name:WALLS
Suffix:
Gender:F
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 PILSON RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-6487
Mailing Address - Country:US
Mailing Address - Phone:919-297-8171
Mailing Address - Fax:
Practice Address - Street 1:2515 WATSON AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-6173
Practice Address - Country:US
Practice Address - Phone:919-297-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17939101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health