Provider Demographics
NPI:1396879052
Name:WALTER, JANE A (LPC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:WALTER
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 1:2900 CHAMBLEE TUCKER RD
Mailing Address - Street 2:BLDG 8
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4100
Mailing Address - Country:US
Mailing Address - Phone:404-376-5987
Mailing Address - Fax:770-695-1020
Practice Address - Street 1:2900 CHAMBLEE TUCKER RD
Practice Address - Street 2:BLDG 8
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4100
Practice Address - Country:US
Practice Address - Phone:404-376-5987
Practice Address - Fax:770-695-1020
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002438101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional