Provider Demographics
NPI:1043232408
Name:WALTERS, WILLIAM P (LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:P
Last Name:WALTERS
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 INDEPENDENCE BLVD
Mailing Address - Street 2:PEMBROKE 2, SUITE 219
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2962
Mailing Address - Country:US
Mailing Address - Phone:757-490-6960
Mailing Address - Fax:757-490-6995
Practice Address - Street 1:287 INDEPENDENCE BLVD
Practice Address - Street 2:PEMBROKE 2, SUITE 219
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2962
Practice Address - Country:US
Practice Address - Phone:757-490-6960
Practice Address - Fax:757-490-6995
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001157101YP2500X
VA0717000866106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5411840Medicaid