Provider Demographics
NPI:1467765305
Name:WALTER, DOUGLAS A (LPC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:WALTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-0427
Mailing Address - Country:US
Mailing Address - Phone:919-658-7500
Mailing Address - Fax:919-658-7509
Practice Address - Street 1:1010 N BREAZEALE AVE
Practice Address - Street 2:UNIT C
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-1106
Practice Address - Country:US
Practice Address - Phone:919-658-7500
Practice Address - Fax:919-658-7509
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional