Healthcare Provider Details

I. General information

NPI: 1881133411
Provider Name (Legal Business Name): ALAN WALTER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 DUG GAP RD
DALTON GA
30720-5007
US

IV. Provider business mailing address

129 STANLEY PKWY
RINGGOLD GA
30736-6533
US

V. Phone/Fax

Practice location:
  • Phone: 706-279-0405
  • Fax: 706-279-4190
Mailing address:
  • Phone: 423-667-9749
  • Fax: 706-279-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008995
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: