Provider Demographics
NPI:1114297900
Name:WALTERS, JOY R (LCPC-C)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:R
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:R
Other - Last Name:LEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:189 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:207-942-7013
Practice Address - Street 1:265 HAMMOND ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4610
Practice Address - Country:US
Practice Address - Phone:207-942-5055
Practice Address - Fax:207-942-7013
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3908101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional