Healthcare Provider Details

I. General information

NPI: 1255235339
Provider Name (Legal Business Name): JERMAINE WALKER LPC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 ANDERSON RD S STE 302B
ROCK HILL SC
29730-3392
US

IV. Provider business mailing address

526 BRIGHAM TRL # 526
AUGUSTA GA
30909-6046
US

V. Phone/Fax

Practice location:
  • Phone: 843-938-4592
  • Fax:
Mailing address:
  • Phone: 678-620-8248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10737
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10737
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: