Healthcare Provider Details

I. General information

NPI: 1750388914
Provider Name (Legal Business Name): WALTER T LITTLE III M.ED LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 CREEK HAVEN DR
HOLLY SPRINGS NC
27540-8372
US

IV. Provider business mailing address

804 CREEK HAVEN DR
HOLLY SPRINGS NC
27540-8372
US

V. Phone/Fax

Practice location:
  • Phone: 919-362-0577
  • Fax: 919-680-4883
Mailing address:
  • Phone: 919-362-0577
  • Fax: 919-680-4883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4713
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4713
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: