Healthcare Provider Details

I. General information

NPI: 1952030587
Provider Name (Legal Business Name): ENEZIAH WALTERS LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 S CREYTS RD STE D
LANSING MI
48917-8269
US

IV. Provider business mailing address

134 W MAPLE ST
MASON MI
48854-1657
US

V. Phone/Fax

Practice location:
  • Phone: 517-512-5289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MARY BETH HOUPT
Title or Position: CREDENTIALING
Credential:
Phone: 517-676-9797