Healthcare Provider Details

I. General information

NPI: 1194556100
Provider Name (Legal Business Name): ANDREA WALKER PRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 LINDEN AVE
DAYTON OH
45432-3028
US

IV. Provider business mailing address

1348 E INNIS AVE
COLUMBUS OH
43207-2132
US

V. Phone/Fax

Practice location:
  • Phone: 614-300-5878
  • Fax:
Mailing address:
  • Phone: 216-340-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.163031
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2613968
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.005664
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: