Provider Demographics
NPI:1144703703
Name:WALLER, URANDA MAE (LCSW, CCTP)
Entity type:Individual
Prefix:MRS
First Name:URANDA
Middle Name:MAE
Last Name:WALLER
Suffix:
Gender:F
Credentials:LCSW, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 CHRISTIAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-3461
Mailing Address - Country:US
Mailing Address - Phone:434-637-6677
Mailing Address - Fax:757-500-8075
Practice Address - Street 1:820 GREENBRIER CIRCLE
Practice Address - Street 2:SUITE 32
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2646
Practice Address - Country:US
Practice Address - Phone:757-756-8741
Practice Address - Fax:757-500-8075
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040103731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical