Healthcare Provider Details

I. General information

NPI: 1376256339
Provider Name (Legal Business Name): SHAYLA WALKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MEDICAL DR
HAMPTON VA
23666-1769
US

IV. Provider business mailing address

449 NEWPORT NEWS AVE
HAMPTON VA
23669-3926
US

V. Phone/Fax

Practice location:
  • Phone: 757-788-0600
  • Fax:
Mailing address:
  • Phone: 757-256-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014730
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: