Healthcare Provider Details

I. General information

NPI: 1669317996
Provider Name (Legal Business Name): AMANDA WALTERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 HOOVER RD
GROVE CITY OH
43123-9122
US

IV. Provider business mailing address

4653 E MAIN ST
WHITEHALL OH
43213-3298
US

V. Phone/Fax

Practice location:
  • Phone: 614-359-8109
  • Fax:
Mailing address:
  • Phone: 614-359-8109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2607975
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: