Healthcare Provider Details

I. General information

NPI: 1497768121
Provider Name (Legal Business Name): ELAINE WALKER MSW, ACSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109B WEST MILL ST.
ELIZABETHTOWN NC
28337
US

IV. Provider business mailing address

PO BOX 963
LUMBERTON NC
28359-0963
US

V. Phone/Fax

Practice location:
  • Phone: 910-862-3286
  • Fax: 910-862-7038
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC001912
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: