Healthcare Provider Details

I. General information

NPI: 1538819743
Provider Name (Legal Business Name): ERICKA DOMINQUE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 GLEBE AVE
BRONX NY
10461-3109
US

IV. Provider business mailing address

365 W 125TH ST UNIT 2586
NEW YORK NY
10027-9465
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-4400
  • Fax:
Mailing address:
  • Phone: 646-575-7727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number112556
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: