Provider Demographics
NPI:1629331970
Name:WALRATH, MARTHA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:M
Last Name:WALRATH
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 1:166 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-3536
Mailing Address - Country:US
Mailing Address - Phone:828-884-6553
Mailing Address - Fax:
Practice Address - Street 1:166 PARK AVE
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3536
Practice Address - Country:US
Practice Address - Phone:828-884-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical