Provider Demographics
NPI:1790968790
Name:WALTHER, SALLY EILEEN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:EILEEN
Last Name:WALTHER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 16TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-1401
Mailing Address - Country:US
Mailing Address - Phone:202-289-1510
Mailing Address - Fax:202-518-8922
Practice Address - Street 1:1509 16TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1401
Practice Address - Country:US
Practice Address - Phone:202-289-1510
Practice Address - Fax:202-518-8922
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC301803104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker