NPI 1063783462

Tina Marie Wallis, LPCCPCS

Practitioner Professional Counselor Dawsonville, GA

Practice location

Address: 12 Waterfront Park CT, Dawsonville, GA 30534-5772
Phone: (706) 490-9204

Registered specialties

Professional Counselor Primary

Behavioral Health & Social Service Providers Taxonomy 101YP2500X Licence 006897 (GA)

Other Counselor providers in Georgia →

Registry record

NPI: 1063783462
Entity type: Individual
Sex (as registered): Female
NPI issued: 18 Jan 2012
Record last updated: 17 Dec 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.