Healthcare Provider Details

I. General information

NPI: 1053368068
Provider Name (Legal Business Name): BELINDA LARK WALKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 CARL DR
THOMSON GA
30824-3856
US

IV. Provider business mailing address

1 FREEDOM WAY AUGUSTA VA MEDICAL CENTER
AUGUSTA GA
30904-6285
US

V. Phone/Fax

Practice location:
  • Phone: 706-595-2792
  • Fax:
Mailing address:
  • Phone: 706-733-0188
  • Fax: 706-731-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000424
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: