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Individual

MITZI LEE WALTERS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
R.N., M.A., LAPC

Contact information

Practice address
1640 POWERS FERRY RD SE, BUILDING 9, SUITE 100, MARIETTA, GA 30067-5491
(770) 953-0080
(770) 953-0031
Mailing address
1640 POWERS FERRY RD SE, BUILDING 9, SUITE 100, MARIETTA, GA 30067-5491
(770) 953-0080
(770) 953-0031

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
APC001758
GA
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN057578
GA

Other

Enumeration date
09/01/2010
Last updated
09/01/2010
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