1487619748 NPI number — MR. WALTER LEO HAIR JR. LMSW, CSWM

Table of content: MR. WALTER LEO HAIR JR. LMSW, CSWM (NPI 1487619748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487619748 NPI number — MR. WALTER LEO HAIR JR. LMSW, CSWM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAIR
Provider First Name:
WALTER
Provider Middle Name:
LEO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
LMSW, CSWM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAIR
Provider Other First Name:
WALTER
Provider Other Middle Name:
LEO
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
LMSW, CSWM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1487619748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4936 CATALPA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPE MILLS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28348-8886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-425-9647
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VETERAN'S ADMINISTRATION MEDICAL CENTER
Provider Second Line Business Practice Location Address:
2300 RAMSEY STREET
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-488-2120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  6801080049 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 6801080049 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)