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General NPI Number Information
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NPI Number | 1003526229
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Entity Type | Individual
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Provider Name | JACQUELYN WALKER
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Gender | Female
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 460 LANGDON ST
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City | SPARTANBURG
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State | SC
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Zip | 29302-1614
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Country | US
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Telephone | 864-549-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 147 BROOKMONT LN
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City | FOUNTAIN INN
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State | SC
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Zip | 29644-9314
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Country | US
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Telephone | 803-570-6446
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10553
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License Number State | SC
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