Healthcare Provider Details

I. General information

NPI: 1104082981
Provider Name (Legal Business Name): EARL EUGENE WALKER JR. ED.D., CCHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MORNING DEW DR
MIDDLETOWN DE
19709-2419
US

IV. Provider business mailing address

9 MORNING DEW DR
MIDDLETOWN DE
19709-2419
US

V. Phone/Fax

Practice location:
  • Phone: 302-312-8221
  • Fax:
Mailing address:
  • Phone: 302-312-8221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberB1-0000757
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: