Provider Demographics
NPI:1043236060
Name:WALTER, MICHELLE JOAN (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:JOAN
Last Name:WALTER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CORPORATE WOODS DR
Mailing Address - Street 2:STE 400
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4429
Mailing Address - Country:US
Mailing Address - Phone:757-459-4640
Mailing Address - Fax:757-459-4643
Practice Address - Street 1:260 GRAYSON ROAD
Practice Address - Street 2:JEWISH FAMILY SERVICE OF TIDEWATER INC
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4345
Practice Address - Country:US
Practice Address - Phone:757-459-4640
Practice Address - Fax:757-459-4643
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040029191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8909164Medicaid
VA076707OtherBLUE CROSS
C02752Medicare UPIN
VA800001421Medicare ID - Type Unspecified