Provider Demographics
NPI:1811258411
Name:WALTI, JOHANNA (LCSW-C)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:WALTI
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1745
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1745
Mailing Address - Country:US
Mailing Address - Phone:301-759-5280
Mailing Address - Fax:301-777-5630
Practice Address - Street 1:12503 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2554
Practice Address - Country:US
Practice Address - Phone:301-759-5280
Practice Address - Fax:301-777-5630
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD083671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical