Provider Demographics
NPI:1730932062
Name:WALTERS, RICKEY H JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:RICKEY
Middle Name:H
Last Name:WALTERS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 BARTRAM PARK BLVD APT 1527
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5440
Mailing Address - Country:US
Mailing Address - Phone:904-635-2270
Mailing Address - Fax:
Practice Address - Street 1:12700 BARTRAM PARK BLVD APT 1527
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5440
Practice Address - Country:US
Practice Address - Phone:904-635-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL223111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical