Individual
MR. JOHN CHRISTIAN WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
3705 LATROBE DR STE 340, CHARLOTTE, NC 28211
(704) 364-3989
Mailing address
3705 LATROBE DR STE 340, CHARLOTTE, NC 28211-4823
(704) 364-3989
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
5049
NC
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730306630
—
NC
Enumeration date
04/20/2007
Last updated
12/27/2018
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