| Doctor Name: | JUSTIN C. WALTERS |
| NPI Number: | 1114338365 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS |
| License Number: | |
| Business Practice Address: | 801 Old York Rd Suite 310 Jenkintown, PA - 190461611 |
| Business Phone Number: | 6106446464 |
| Business Fax Number: | 6109816078 |
| Mailing Address: | 1440 Russell Rd, PAOLI |
| State: | PA |
| Postal Code: | 193011236 |
| Phone Number: | 6106446464 |
| Fax Number: | 6109816078 |
| NPI Enumeration Date: | 05/09/2014 |
| NPI Last Update Date: | 05/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |