Provider Demographics
NPI:1043593908
Name:WALTERS, MALEKA NICOLE (LMFT)
Entity Type:Individual
Prefix:
First Name:MALEKA
Middle Name:NICOLE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 CARLISLE DR
Mailing Address - Street 2:STE 112
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4882
Mailing Address - Country:US
Mailing Address - Phone:703-481-6001
Mailing Address - Fax:703-481-6554
Practice Address - Street 1:481 CARLISLE DR
Practice Address - Street 2:STE 112
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4882
Practice Address - Country:US
Practice Address - Phone:703-481-6001
Practice Address - Fax:703-481-6554
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA071701232106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist