Healthcare Provider Details

I. General information

NPI: 1003738493
Provider Name (Legal Business Name): MIKAL WALKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25670 PLEASANT VALLEY RD
CHANTILLY VA
20152-1406
US

IV. Provider business mailing address

25670 PLEASANT VALLEY RD
CHANTILLY VA
20152-1406
US

V. Phone/Fax

Practice location:
  • Phone: 703-314-6759
  • Fax:
Mailing address:
  • Phone: 703-314-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number20823
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: