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General NPI Number Information
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NPI Number | 1487470209
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Entity Type | Individual
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Provider Name | MACKENZIE WALTERS
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Gender | Female
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 825 DILIGENCE DR STE 102B
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4229
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Country | US
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Telephone | 254-249-6530
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Fax |
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Provider Business Mailing Address
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Address Line | 18 EDGEMONT DR
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City | HAMPTON
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State | VA
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Zip | 23666-1419
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Country | US
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Telephone | 757-582-2044
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | RBT-22-199602
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License Number State | GA
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