Provider Demographics
NPI:1356656599
Name:WALTERS, MICHELLE R (LCMHC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5306
Mailing Address - Country:US
Mailing Address - Phone:910-489-9170
Mailing Address - Fax:910-484-5781
Practice Address - Street 1:114 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5306
Practice Address - Country:US
Practice Address - Phone:910-489-9170
Practice Address - Fax:910-484-5781
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health