Healthcare Provider Details

I. General information

NPI: 1710892807
Provider Name (Legal Business Name): GENESIS WALKER LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LOOP STREET
CLINTON NC
28328-3402
US

IV. Provider business mailing address

100 LOOP STREET
CLINTON NC
28328-3402
US

V. Phone/Fax

Practice location:
  • Phone: 910-596-2221
  • Fax:
Mailing address:
  • Phone: 910-596-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024351
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: