Healthcare Provider Details

I. General information

NPI: 1952607103
Provider Name (Legal Business Name): ESSENCE M WALKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 GRIFFITH RD
CEDARBLUFF MS
39741-9027
US

IV. Provider business mailing address

434 GRIFFITH RD
CEDARBLUFF MS
39741-9027
US

V. Phone/Fax

Practice location:
  • Phone: 662-352-1638
  • Fax:
Mailing address:
  • Phone: 662-352-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2378
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: