Healthcare Provider Details

I. General information

NPI: 1548080237
Provider Name (Legal Business Name): ALICE WALKER LPCC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11603 ROAD 27.3
DOLORES CO
81323-9249
US

IV. Provider business mailing address

11603 ROAD 27.3
DOLORES CO
81323-9249
US

V. Phone/Fax

Practice location:
  • Phone: 502-439-6410
  • Fax:
Mailing address:
  • Phone: 502-439-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALICE ELIZABETH WALKER
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 502-439-6410