Healthcare Provider Details

I. General information

NPI: 1588153902
Provider Name (Legal Business Name): WILLIAM WESLEY WALKER III LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8529 N DIXIE DR STE 150
DAYTON OH
45414-2476
US

IV. Provider business mailing address

1411 N FAIRFIELD RD
BEAVERCREEK OH
45432-2637
US

V. Phone/Fax

Practice location:
  • Phone: 937-387-8080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2002028
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: