Healthcare Provider Details

I. General information

NPI: 1790381846
Provider Name (Legal Business Name): RACHAEL MONICA WALKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 LAKELAND DR STE 311
JACKSON MS
39216-4852
US

IV. Provider business mailing address

303 PENROSE PL
MADISON MS
39110-1200
US

V. Phone/Fax

Practice location:
  • Phone: 601-540-8877
  • Fax:
Mailing address:
  • Phone: 601-540-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2405
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2405
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: