Healthcare Provider Details

I. General information

NPI: 1427073618
Provider Name (Legal Business Name): ROSLYN MILLER WALKER MA, LPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 J N PEASE PL STE 204
CHARLOTTE NC
28262-4543
US

IV. Provider business mailing address

1931 J N PEASE PL STE 204
CHARLOTTE NC
28262-4543
US

V. Phone/Fax

Practice location:
  • Phone: 704-717-2800
  • Fax: 704-717-6200
Mailing address:
  • Phone: 704-717-2800
  • Fax: 704-717-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1526
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: