Individual provider · Type 1 NPI
Gina Thara Wall, LPC
Professional Counselor · Eagle River, AK
NPI number
1073121752
Active
Practice location
17601 James Way
Eagle River, AK 99577-9254
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Professional Counselor Primary | 101YP2500X | 159747 (AK) |
Professional Counselor: Definition to come...
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About NPI 1073121752
Gina Thara Wall, LPC's National Provider Identifier is 1073121752, issued on Jul 17, 2020. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Eagle River, AK. The record was last updated on Jul 17, 2020.