Provider Demographics
NPI:1982731584
Name:ABBOTT, WALTER AMOS JR (LCAS, LPC)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:AMOS
Last Name:ABBOTT
Suffix:JR
Gender:M
Credentials:LCAS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 WILSON COFFEY RD
Mailing Address - Street 2:
Mailing Address - City:BLOWING ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28605
Mailing Address - Country:US
Mailing Address - Phone:828-295-7762
Mailing Address - Fax:
Practice Address - Street 1:820 STATE FARM RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4996
Practice Address - Country:US
Practice Address - Phone:828-262-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC905101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)