Healthcare Provider Details

I. General information

NPI: 1952875239
Provider Name (Legal Business Name): GISELA MICHELLE EVERETT WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2019
Last Update Date: 01/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 SAND MINE RD
DAVENPORT FL
33897-3402
US

IV. Provider business mailing address

2148 WHITE EAGLE ST
CLERMONT FL
34714-8068
US

V. Phone/Fax

Practice location:
  • Phone: 407-910-2941
  • Fax:
Mailing address:
  • Phone: 352-242-3832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH17947
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: