Provider Demographics
NPI:1659018539
Name:WALSH, AMY
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:723 INDUSTRIAL PARK DR UNIT A723
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4352
Mailing Address - Country:US
Mailing Address - Phone:706-514-6341
Mailing Address - Fax:
Practice Address - Street 1:723 INDUSTRIAL PARK DR UNIT A
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4352
Practice Address - Country:US
Practice Address - Phone:706-514-6341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health