Provider Demographics
NPI:1215407416
Name:WALTERS, CANDY RENITA (MS)
Entity Type:Individual
Prefix:MRS
First Name:CANDY
Middle Name:RENITA
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3118 H G MOSLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2941
Mailing Address - Country:US
Mailing Address - Phone:903-200-1433
Mailing Address - Fax:903-405-4047
Practice Address - Street 1:3118 H G MOSLEY PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2941
Practice Address - Country:US
Practice Address - Phone:903-200-1433
Practice Address - Fax:903-405-4047
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62377101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional