Provider Demographics
NPI:1689224800
Name:WALTERS, KIAYA A D (LPC)
Entity type:Individual
Prefix:
First Name:KIAYA
Middle Name:A D
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KIAYA
Other - Middle Name:A
Other - Last Name:DEMONBREUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1331 ELMWOOD AVE STE 300B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 ELMWOOD AVE STE 300B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2150
Practice Address - Country:US
Practice Address - Phone:803-250-5109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7165101YM0800X, 101YP2500X
SC8374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional