MEDICARE: WALGREN COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C006450	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	A150	OTHER	NC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235422742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREN COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	3021 SENNA DR STE B
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-6727
Country	:	US
Telephone Number	:	704-443-0144
Fax Number	:	313-692-6033

Provider Business Practice Location Address
First Line	:	3021 SENNA DR STE B
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-6727
Country	:	US
Telephone Number	:	704-443-0144
Fax Number	:	313-692-6033

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KRISTY WALGREN
Credential	:	MSW LCSW
Telephone Number	:	704-443-0144

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	06/19/2019

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