Provider Demographics
NPI:1750388914
Name:LITTLE, WALTER T III (MED LPC)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:T
Last Name:LITTLE
Suffix:III
Gender:M
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 CREEK HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8372
Mailing Address - Country:US
Mailing Address - Phone:919-362-0577
Mailing Address - Fax:919-680-4883
Practice Address - Street 1:804 CREEK HAVEN DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-8372
Practice Address - Country:US
Practice Address - Phone:919-362-0577
Practice Address - Fax:919-680-4883
Is Sole Proprietor?:No
Enumeration Date:2005-07-02
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4713101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102010Medicaid