Individual
CAROLE LYNN WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW, BFA
Contact information
Practice address
959 WEALTHY ST SE, GRAND RAPIDS, MI 49506-2519
(616) 451-9650
Mailing address
959 WEALTHY ST SE, GRAND RAPIDS, MI 49506-2519
(616) 451-9650
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
L2395721
MI
101YM0800X
Mental Health Counselor
L2395721
MI
101YP2500X
Professional Counselor
L2395721
MI
1041C0700X
Clinical Social Worker
Primary
L2395721
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376866160
—
MI
Enumeration date
02/22/2013
Last updated
02/12/2016
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