Healthcare Provider Details

I. General information

NPI: 1366676876
Provider Name (Legal Business Name): LESLIE ANNE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 DANZIG PLZ SUITE 102
CONCORD CA
94520-7979
US

IV. Provider business mailing address

1850 GATEWAY BLVD SUITE 900
CONCORD CA
94520-3279
US

V. Phone/Fax

Practice location:
  • Phone: 925-399-8747
  • Fax: 925-399-8750
Mailing address:
  • Phone: 925-825-4700
  • Fax: 925-825-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: