Provider Demographics
NPI:1720479611
Name:WALTER, VANESSA M (LCSWA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:WALTER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:M
Other - Last Name:KLIEFOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:952 COPPERFIELD BLVD NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2433
Mailing Address - Country:US
Mailing Address - Phone:704-786-7918
Mailing Address - Fax:704-786-7709
Practice Address - Street 1:952 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2433
Practice Address - Country:US
Practice Address - Phone:704-786-7918
Practice Address - Fax:704-786-7709
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0092631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical