Healthcare Provider Details

I. General information

NPI: 1689021644
Provider Name (Legal Business Name): LETECIA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9441 COMMON ST STE B
BATON ROUGE LA
70809
US

IV. Provider business mailing address

PO BOX 266
BRUSLY LA
70719-0266
US

V. Phone/Fax

Practice location:
  • Phone: 225-923-3733
  • Fax:
Mailing address:
  • Phone: 225-475-1522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: