Provider Demographics
NPI:1053062729
Name:WALSTON, KARLIE BRASWELL (MS, LCMHC-A, LCAS-A)
Entity Type:Individual
Prefix:MRS
First Name:KARLIE
Middle Name:BRASWELL
Last Name:WALSTON
Suffix:
Gender:F
Credentials:MS, LCMHC-A, LCAS-A
Other - Prefix:
Other - First Name:KARLIE
Other - Middle Name:DREW
Other - Last Name:BRASWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCMHC-A, LCAS-A
Mailing Address - Street 1:3709 NASH ST NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1127
Mailing Address - Country:US
Mailing Address - Phone:252-567-9495
Mailing Address - Fax:
Practice Address - Street 1:403 E NASH ST UNIT B
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2461
Practice Address - Country:US
Practice Address - Phone:252-477-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17224101YM0800X
NCLCAS-27757101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)