Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Liam Nikolas Jaxson Waller, LCSWA

Individual provider Clinical Social Worker · NPI 1780254136

Mr. Liam Nikolas Jaxson Waller, LCSWA is a Clinical Social Worker in Boone, North Carolina. Licensed in North Carolina. Registered with an NPI since 2021.

Licensed in
NC
In the registry since
2021

Practice location Address checks out

895 State Farm Rd Ste 507-5
Boone, NC 28607-4917
Phone: (828) 338-3136
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence P016334 (NC)

Record details

NPI number1780254136
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSWA
Sole proprietorNo
NPI enumeratedJune 28, 2021
Last updated in NPPESJune 28, 2021
Certification dateJune 28, 2021

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