Healthcare Provider Details

I. General information

NPI: 1811502974
Provider Name (Legal Business Name): CHERYL D WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BUFORD HWY NE STE 195
BROOKHAVEN GA
30329-2124
US

IV. Provider business mailing address

1998 NORTHSIDE DR NW
ATLANTA GA
30318-2672
US

V. Phone/Fax

Practice location:
  • Phone: 770-284-1044
  • Fax: 404-228-3860
Mailing address:
  • Phone: 734-320-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC007218
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: