Provider Demographics
NPI:1417394735
Name:WALTERS, ANITA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 S MOUNT VERNON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-4146
Mailing Address - Country:US
Mailing Address - Phone:724-550-4343
Mailing Address - Fax:
Practice Address - Street 1:253 S MOUNT VERNON AVE FL 2
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-4146
Practice Address - Country:US
Practice Address - Phone:724-550-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW012966OtherPENNSYLVANIA LICENSING BOARD