Provider Demographics
NPI:1992241053
Name:WALLS, LISA MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:WALLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-4249
Mailing Address - Country:US
Mailing Address - Phone:229-276-0100
Mailing Address - Fax:229-276-0300
Practice Address - Street 1:215 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-4249
Practice Address - Country:US
Practice Address - Phone:229-276-0100
Practice Address - Fax:229-276-0300
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0050581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical