Healthcare Provider Details

I. General information

NPI: 1386341824
Provider Name (Legal Business Name): MR. DARRYL WALKER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 PARK AVE
CRANSTON RI
02910-3225
US

IV. Provider business mailing address

65 ROSE ST
NORTH PROVIDENCE RI
02904-5018
US

V. Phone/Fax

Practice location:
  • Phone: 401-461-5056
  • Fax:
Mailing address:
  • Phone: 401-996-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21382
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00873
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: