Provider Demographics
NPI:1487619748
Name:HAIR, WALTER LEO JR (LMSW, CSWM)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:LEO
Last Name:HAIR
Suffix:JR
Gender:M
Credentials:LMSW, CSWM
Other - Prefix:MR
Other - First Name:WALTER
Other - Middle Name:LEO
Other - Last Name:HAIR
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LMSW, CSWM
Mailing Address - Street 1:4936 CATALPA CIR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-8886
Mailing Address - Country:US
Mailing Address - Phone:910-425-9647
Mailing Address - Fax:
Practice Address - Street 1:VETERAN'S ADMINISTRATION MEDICAL CENTER
Practice Address - Street 2:2300 RAMSEY STREET
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301
Practice Address - Country:US
Practice Address - Phone:910-488-2120
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801080049104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical