Provider Demographics
NPI:1790813665
Name:WALDRON, TRAVIS (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:WALDRON
Suffix:
Gender:F
Credentials:MSW, LCSW
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 4
Mailing Address - Street 2:
Mailing Address - City:GERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28735-0004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:267 CHESTNUT HILL RD STE 4
Practice Address - Street 2:
Practice Address - City:GERTON
Practice Address - State:NC
Practice Address - Zip Code:28735-0077
Practice Address - Country:US
Practice Address - Phone:828-625-0344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003249101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health