MEDICARE: MALEKA WALTERS LLC

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	106H00000X	Marriage & Family Therapist	0717001232	VA

General Provider Information

NPI Number	:	1740658269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALEKA WALTERS LLC

Provider Business Mailing Address
First Line	:	1485 CHAIN BRIDGE RD
Second Line	:	STE 203
City	:	MC LEAN
State	:	VA
Zip	:	22101-4501
Country	:	US
Telephone Number	:	703-474-7410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1485 CHAIN BRIDGE RD
Second Line	:	STE 203
City	:	MC LEAN
State	:	VA
Zip	:	22101-4501
Country	:	US
Telephone Number	:	703-474-7410
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MARRIAGE AND FAMILY THERAP
Name	:	MALEKA WALTERS
Credential	:
Telephone Number	:	703-474-7410

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	09/15/2015

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