Provider Information for 1295410751
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BRENT AUSTIN WALTER LCPC
Sex: Male
NPI: 1295410751
Last Updated: 2023-06-21
Certification Date: 2023-06-21
Certification Date: 2023-06-21
Details
| Name | Value | ||||||||
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| NPI | 1295410751 | ||||||||
| Enumeration Date | 2023-06-21 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 803 BUCKINGHAM RD CUMBERLAND, MD 21502-2759 United States Phone: 301-338-1686 | Fax: | ||||||||
| Primary Practice Address | 803 BUCKINGHAM RD CUMBERLAND, MD 21502-2759 United States Phone: 301-338-1686 | Fax: | ||||||||
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