MEDICARE: KIAYA A. D. WALTERS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	7165	SC
2	101YP2500X	Professional Counselor	7165	SC
3	101YM0800X	Mental Health Counselor	8374	SC

General Provider Information

NPI Number	:	1689224800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIAYA A. D. WALTERS LPC

Provider Business Mailing Address
First Line	:	1331 ELMWOOD AVE STE 300B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2150
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1331 ELMWOOD AVE STE 300B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2150
Country	:	US
Telephone Number	:	803-250-5109
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	11/18/2024

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