Provider Demographics
NPI:1235347451
Name:WARNECK, JR., WALTER JOHN (DMIN)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JOHN
Last Name:WARNECK, JR.
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LEEWARD PSGE
Mailing Address - Street 2:WINDMILL HARBOUR
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-5209
Mailing Address - Country:US
Mailing Address - Phone:843-681-6981
Mailing Address - Fax:
Practice Address - Street 1:301 WATERS EDGE
Practice Address - Street 2:SHELTER COVE
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-9329
Practice Address - Country:US
Practice Address - Phone:843-686-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
SC1125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist