| Doctor Name: | ALYSA GREDEL WALL |
| NPI Number: | 1881997468 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | PS-P000213 |
| Business Practice Address: | 1276 Mcconnell Dr Suite C Decatur, GA - 300333508 |
| Business Phone Number: | 4049299009 |
| Business Fax Number: | 4049299005 |
| Mailing Address: | 1276 Mcconnell Dr, Suite C DECATUR |
| State: | GA |
| Postal Code: | 300333508 |
| Phone Number: | 4049299009 |
| Fax Number: | 4049299005 |
| NPI Enumeration Date: | 12/21/2010 |
| NPI Last Update Date: | 12/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | PS-P000213 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |