Healthcare Provider Details

I. General information

NPI: 1992680482
Provider Name (Legal Business Name): CHASITY ANTOINETTE WALTERS LCSWA, LCASA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 SPRING DR
GARNER NC
27529-3486
US

IV. Provider business mailing address

3125 POPLARWOOD CT STE 203
RALEIGH NC
27604-6445
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-6131
  • Fax: 919-571-2932
Mailing address:
  • Phone: 919-787-6131
  • Fax: 919-571-2932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022779
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-31186
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: