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General NPI Number Information
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NPI Number | 1306612494
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Entity Type | Individual
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Provider Name | JESSICA L WALKER CADC
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Gender | Female
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Dates
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Enumeration Date | 11/29/2023
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 14 WINTER ST
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City | SANFORD
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State | ME
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Zip | 04073-3322
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Country | US
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Telephone | 207-324-4054
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Fax | 207-324-4074
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Provider Business Mailing Address
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Address Line | PO BOX 174
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City | LEBANON
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State | ME
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Zip | 04027-0174
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Country | US
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Telephone | 603-781-9384
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAC8650
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License Number State | ME
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