Healthcare Provider Details

I. General information

NPI: 1710258025
Provider Name (Legal Business Name): COLETTE WALKER-THOMAS M.S.W, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7516 ROXY DR
WINDSOR MILL MD
21244-2063
US

IV. Provider business mailing address

7516 ROXY DR
WINDSOR MILL MD
21244-2063
US

V. Phone/Fax

Practice location:
  • Phone: 443-392-4095
  • Fax: 410-655-4243
Mailing address:
  • Phone: 443-392-4095
  • Fax: 410-655-4243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09889
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: