| Doctor Name: | ELIZABETH G. WALLNER |
| NPI Number: | 1457581548 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | CC3943 |
| Business Practice Address: | 453 Us Route 1 Kittery, ME - 039045513 |
| Business Phone Number: | 2074511750 |
| Business Fax Number: | 2074394360 |
| Mailing Address: | 78 Atlantic Pl, SOUTH PORTLAND |
| State: | ME |
| Postal Code: | 041062316 |
| Phone Number: | 2078427701 |
| Fax Number: | 2078427773 |
| NPI Enumeration Date: | 07/23/2009 |
| NPI Last Update Date: | 11/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | CC3943 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |