Provider Demographics
NPI:1073921532
Name:WALTERS, DOROTHY S
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:S
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MALLORY STATION RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2823
Mailing Address - Country:US
Mailing Address - Phone:615-439-8656
Mailing Address - Fax:
Practice Address - Street 1:301 MALLORY STATION RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2823
Practice Address - Country:US
Practice Address - Phone:615-439-8656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health