Provider Demographics
NPI:1962809996
Name:WALTERS, RITA RANEE (PHD)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:RANEE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 COVINGTON CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4941
Mailing Address - Country:US
Mailing Address - Phone:517-977-0899
Mailing Address - Fax:517-977-0939
Practice Address - Street 1:2929 COVINGTON CT
Practice Address - Street 2:SUITE 201
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4941
Practice Address - Country:US
Practice Address - Phone:517-977-0899
Practice Address - Fax:517-977-0939
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010858991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical