Provider Demographics
NPI:1477097087
Name:WALTERS, BILLIE (LMSW)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:
Other - Last Name:NOWICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2551 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MI
Mailing Address - Zip Code:49328-9611
Mailing Address - Country:US
Mailing Address - Phone:616-550-5957
Mailing Address - Fax:
Practice Address - Street 1:2551 20TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MI
Practice Address - Zip Code:49328-9611
Practice Address - Country:US
Practice Address - Phone:616-550-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010966351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical