Provider Demographics
NPI:1063447886
Name:WALTERS, MARNIE MYERS (LCSW)
Entity type:Individual
Prefix:
First Name:MARNIE
Middle Name:MYERS
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LCSW
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 27
Mailing Address - Street 2:
Mailing Address - City:BAKERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28705-0027
Mailing Address - Country:US
Mailing Address - Phone:828-688-2104
Mailing Address - Fax:
Practice Address - Street 1:116 SEVEN MILE RIDGE RD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-8509
Practice Address - Country:US
Practice Address - Phone:828-675-4116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0033721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002547Medicaid
NC13283OtherBLUE CROSS & BLUE SHIELD
NC6002547Medicaid