Provider Demographics
NPI:1487336012
Name:WALTERS, KERRIE (LCSWA)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 GLENVILLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3964
Mailing Address - Country:US
Mailing Address - Phone:845-901-0875
Mailing Address - Fax:
Practice Address - Street 1:516 GLENVILLE LAKE DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-3964
Practice Address - Country:US
Practice Address - Phone:845-901-0875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP019359104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker