Healthcare Provider Details

I. General information

NPI: 1902585490
Provider Name (Legal Business Name): RASHAWNDA MONIQUE WALKER PSYD, PLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 YOUREE DR STE 20A
SHREVEPORT LA
71105-2149
US

IV. Provider business mailing address

3341 YOUREE DR
SHREVEPORT LA
71105-2149
US

V. Phone/Fax

Practice location:
  • Phone: 318-425-2000
  • Fax:
Mailing address:
  • Phone: 318-425-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8662
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: