Kevin Waller, LPCS, LCAS, CCS
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Old Fort, NC
NPI 1023596244 · NPPES record last updated Jul 31, 2018
Key facts
- NPI
- 1023596244
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 3145 (NC)
- Practice address
- 363 Graphite Rd
Old Fort, NC 28762-9455 - Phone
- (828) 668-7590
- NPI assigned
- Jul 31, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20998 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| S7822 | NC | MD | Mental Health Counselor |
| 3145 | NC | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Suws of the Carolinas | Past | Accepting new patients | |
| Suws of the Carolinas | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 20998 | NC | |
| Mental Health Counselor | 101YM0800X | S7822 | NC | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 3145 | NC | Yes |
Addresses
Primary practice location
363 Graphite Rd
Old Fort, NC 28762-9455
Mailing address
363 Graphite Rd
Old Fort, NC 28762-9455
Phone (828) 668-7590
Other providers in Old Fort, NC
- John Robert Summerour
- Suws of the Carolinas
- Suws of the Carolinas
- The McDowell Hospital Inc
- Jon Charles Tripp
- Ware Family Medicine PLLC
- Brian Michael Ware
- Wings of Flight Center for Change, PLLC
All providers in Old Fort, NC · Addiction (Substance Use Disorder) Counselor in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.