John Christian Waller, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

3705 Latrobe Dr Ste 340
Charlotte, NC 28211

Phone

(704) 364-3989

NPI assigned

Apr 20, 2007

Last updated

Dec 27, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carolinas Healthcare System Employee Assistance Program

  • General Acute Care Hospital
  • Charlotte, NC
  • NPI 1356560015
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545868800000",
    "number": "1730306630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3705 LATROBE DR STE 340",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282114823",
            "telephone_number": "704-364-3989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3705 LATROBE DR STE 340",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28211",
            "telephone_number": "704-364-3989"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "720 East Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035114",
            "country_code": "US",
            "telephone_number": "704-347-5665",
            "fax_number": "704-355-7287",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3705 Latrobe Dr Ste 340",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "28211",
            "country_code": "US",
            "telephone_number": "704-364-3989",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "JOHN",
        "middle_name": "CHRISTIAN",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2018-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NC",
            "license": "5049",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730306630",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Terry W Wallace, M.D.
• Tonia Wallace, PMHNP-BC
• Stephen Lee Wallenhaupt, MD
• Peter David Wallens, M.S.W.
• Hannah R Waller
• Angela Wallick
• Daniel Brown Wallihan, M.D.
• Casey Raye Wallin, DNP, CRNA
• Gonzalo A Wallis, MD
• Walls Logistics

• Professional Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.