Provider Demographics
NPI:1649604083
Name:WALTHOUR, EDNA
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:WALTHOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-3808
Mailing Address - Country:US
Mailing Address - Phone:912-884-4060
Mailing Address - Fax:
Practice Address - Street 1:543 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-3808
Practice Address - Country:US
Practice Address - Phone:912-884-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor