Provider Demographics
NPI:1235502907
Name:WALTHES, GWENDOLYN MARIE
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:MARIE
Last Name:WALTHES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:MARIE
Other - Last Name:MUSTARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2202 EXECUTIVE DR STE C
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6604
Mailing Address - Country:US
Mailing Address - Phone:757-827-7707
Mailing Address - Fax:
Practice Address - Street 1:223 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5649
Practice Address - Country:US
Practice Address - Phone:757-564-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional