Healthcare Provider Details

I. General information

NPI: 1548135544
Provider Name (Legal Business Name): ERIN MARIE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 W GRANADA BLVD STE 6A
ORMOND BEACH FL
32174-8105
US

IV. Provider business mailing address

37 HULETT WOODS RD
PALM COAST FL
32137-9322
US

V. Phone/Fax

Practice location:
  • Phone: 386-864-0716
  • Fax:
Mailing address:
  • Phone: 386-864-0716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: