Provider Demographics
NPI:1790140713
Name:WEST, WALTER JAMESON JR
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:JAMESON
Last Name:WEST
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 GILEAD LN
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-2792
Mailing Address - Country:US
Mailing Address - Phone:302-331-3559
Mailing Address - Fax:
Practice Address - Street 1:151 GILEAD LN
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-2792
Practice Address - Country:US
Practice Address - Phone:302-331-3559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician