Stehanie D Wall
Community Based Residential Treatment Facility, Mental Illness in Raeford, NC. Individual provider (NPI-1).
NPI number1083045306
StatusActive
Last updated in NPPESJan 9, 2015
Details
- NPI
- 1083045306
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Stehanie D Wall
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Dec 12, 2013
- Last updated
- Jan 9, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | MHL-047-152 | NC | Yes |
| 171M00000X | Case Manager/Care Coordinator | 27-0962043 | SC | |
| 347C00000X | Private Vehicle | 27-0962043 | SC |
Practice location
1357 Wayside RdRaeford, NC 28376-6513
Phone 910-565-2139
Mailing address
3204 High Plains DrHope Mills, NC 28348-5726
Phone 910-674-8605
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