Provider Demographics
NPI:1316650419
Name:YOUNG, WALTER L
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 SPY GLASS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-6965
Mailing Address - Country:US
Mailing Address - Phone:910-916-7812
Mailing Address - Fax:910-401-1591
Practice Address - Street 1:719 SPY GLASS DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-6965
Practice Address - Country:US
Practice Address - Phone:910-916-7812
Practice Address - Fax:910-401-1591
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)