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General NPI Number Information
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NPI Number | 1881133411
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Entity Type | Individual
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Provider Name | ALAN WALTER LPC
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Gender | Male
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 1414 DUG GAP RD
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City | DALTON
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State | GA
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Zip | 30720-5007
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Country | US
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Telephone | 706-279-0405
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Fax | 706-279-4190
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Provider Business Mailing Address
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Address Line | 129 STANLEY PKWY
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City | RINGGOLD
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State | GA
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Zip | 30736-6533
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Country | US
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Telephone | 423-667-9749
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Fax | 706-279-4190
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC008995
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License Number State | GA
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