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General NPI Number Information
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NPI Number | 1518657600
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Entity Type | Individual
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Provider Name | LYDIA WALTERS M.S., ED.S. LPC
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Gender | Female
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 11/02/2025
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Provider Practice Location Address
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Address Line | 1301 SHILOH RD NW STE 710
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City | KENNESAW
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State | GA
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Zip | 30144-7157
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Country | US
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Telephone | 404-242-8692
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Fax |
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Provider Business Mailing Address
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Address Line | 132 PARK AVE E
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City | DALLAS
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State | GA
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Zip | 30157-2181
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC016038
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License Number State | GA
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