Provider Demographics
NPI:1801103684
Name:WALTERS, MITZI LEE (RN, MA, LAPC)
Entity type:Individual
Prefix:
First Name:MITZI
Middle Name:LEE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RN, MA, LAPC
Other - Prefix:
Other - First Name:MITZI
Other - Middle Name:LEE
Other - Last Name:MCTEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MA, LAPC
Mailing Address - Street 1:1640 POWERS FERRY RD SE
Mailing Address - Street 2:BUILDING 9, SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5491
Mailing Address - Country:US
Mailing Address - Phone:770-953-0080
Mailing Address - Fax:770-953-0031
Practice Address - Street 1:1640 POWERS FERRY RD SE
Practice Address - Street 2:BUILDING 9, SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:770-953-0080
Practice Address - Fax:770-953-0031
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC001758101YM0800X
GARN057578163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health