Provider Demographics
NPI:1588697312
Name:WALTERS, VICTORIA ANN
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 INDEPENDENCE BLVD
Mailing Address - Street 2:STE 219
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2956
Mailing Address - Country:US
Mailing Address - Phone:757-490-6960
Mailing Address - Fax:757-490-6995
Practice Address - Street 1:287 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 219
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2962
Practice Address - Country:US
Practice Address - Phone:757-490-6960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040024541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA158237000OtherMAGELLAN
VA438748OtherMAMSI
VA338748OtherMAMSI
VA888936OtherSENTARA
VA333176OtherANTHEMBCBS
VA008930481Medicaid
VA008911762Medicaid
VA2011485OtherCIGNA
VA394091OtherANTHEM BCBS
VA888936OtherSENTARA
VA008911762Medicaid