Healthcare Provider Details

I. General information

NPI: 1093843864
Provider Name (Legal Business Name): RICHARD DAVIS WALKER JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 OLD FLORENCE ROAD
LAWRENCEBURG TN
37454
US

IV. Provider business mailing address

104 WHITE OAK LANE
FLORENCE AL
35633
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-6505
  • Fax: 931-762-3690
Mailing address:
  • Phone: 256-760-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3502
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0046C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: