=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508498395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALKER CONSULTING & PSYCHOLOGICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2020
-----------------------------------------------------
Last Update Date | 02/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4375 COBB PKWY SE STE 121
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-5537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-383-6353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4375 COBB PKWY SE STE 121
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-5537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-383-6353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | ERICA WALKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-383-6353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------