Provider Demographics
NPI:1922341221
Name:WALTERS, ROBERTA ARDELLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:ARDELLE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N WOODROW ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4341
Mailing Address - Country:US
Mailing Address - Phone:501-813-7971
Mailing Address - Fax:
Practice Address - Street 1:101 N WOODROW ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4341
Practice Address - Country:US
Practice Address - Phone:501-813-7971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1303029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional