Individual
CLINTON MICHAEL WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, LCAS
Contact information
Practice address
1001 ROCK QUARRY RD, RALEIGH, NC 27610-3825
(919) 833-3111
Mailing address
1001 ROCK QUARRY RD, RALEIGH, NC 27610-3825
(919) 833-3111
(919) 834-3118
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-23147
NC
1041C0700X
Clinical Social Worker
Primary
C011626
NC
Other
Enumeration date
11/04/2018
Last updated
01/16/2019
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