MEDICARE: WALTER T LITTLE III M.ED LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	4713	NC
2	101YM0800X	Mental Health Counselor	4713	NC

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	:	1750388914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER T LITTLE III M.ED LPC

Provider Business Mailing Address
First Line	:	804 CREEK HAVEN DR
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-8372
Country	:	US
Telephone Number	:	919-362-0577
Fax Number	:	919-680-4883

Provider Business Practice Location Address
First Line	:	804 CREEK HAVEN DR
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-8372
Country	:	US
Telephone Number	:	919-362-0577
Fax Number	:	919-680-4883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2005
Last Update Date	:	12/19/2013

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