Provider Demographics
NPI:1891992079
Name:WALTERS, CAREY ELLENDER (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:ELLENDER
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 STONEY CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-8191
Mailing Address - Country:US
Mailing Address - Phone:225-757-8538
Mailing Address - Fax:
Practice Address - Street 1:1335B WOODDALE BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-2328
Practice Address - Country:US
Practice Address - Phone:225-928-4969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA80251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical