Provider Demographics
NPI:1740437581
Name:CHAVERS, WALTER THOMAS JR (LPC, NCC)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:THOMAS
Last Name:CHAVERS
Suffix:JR
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 BRACKETT ST SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-4611
Mailing Address - Country:US
Mailing Address - Phone:678-481-0978
Mailing Address - Fax:
Practice Address - Street 1:4015 S COBB DR SE STE 10
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6315
Practice Address - Country:US
Practice Address - Phone:678-481-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-23
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional