Healthcare Provider Details

I. General information

NPI: 1063447886
Provider Name (Legal Business Name): MARNIE MYERS WALTERS L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SEVEN MILE RIDGE RD
BURNSVILLE NC
28714-8509
US

IV. Provider business mailing address

PO BOX 27
BAKERSVILLE NC
28705-0027
US

V. Phone/Fax

Practice location:
  • Phone: 828-675-4116
  • Fax:
Mailing address:
  • Phone: 828-688-2104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC003372
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: