Healthcare Provider Details

I. General information

NPI: 1104844281
Provider Name (Legal Business Name): SARALYN L WALKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARALYN LEE

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 E CAPITOL ST 840 TRUST MARK BLDG
JACKSON MS
39201-2503
US

IV. Provider business mailing address

320 E CENTER ST
CANTON MS
39046-3804
US

V. Phone/Fax

Practice location:
  • Phone: 800-632-6074
  • Fax:
Mailing address:
  • Phone: 601-855-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC1771
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: