Provider Demographics
NPI:1497151625
Name:WALTER, BRIANNA NOELLE (LPCA, RBT)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NOELLE
Last Name:WALTER
Suffix:
Gender:F
Credentials:LPCA, RBT
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:NOELLE
Other - Last Name:CLIFTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCA,RBT
Mailing Address - Street 1:10196 FLINT CT SE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9231
Mailing Address - Country:US
Mailing Address - Phone:910-625-5020
Mailing Address - Fax:
Practice Address - Street 1:1328 LAKE PARK BLVD N STE 109
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428
Practice Address - Country:US
Practice Address - Phone:910-707-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
NCA12967101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other