Gina Thara Wall, LPC
NPI #1073121752 in Eagle River, Alaska
Provider Information
- NPI Number
- 1073121752
- Entity Type
- Individual
- Name
- Gina Thara Wall, LPC
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Counselor - Professional
- Credential
- LPC
- Enumeration Date
- Jul 17, 2020
- Last Updated
- Jul 17, 2020
Practice Location
- Address
- 17601 JAMES WAY
- City
- Eagle River
- State
- Alaska
- ZIP Code
- 99577-9254
- Phone
- (907) 854-2344
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Professional — Professional |
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