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General NPI Number Information
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NPI Number | 1528042504
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Entity Type | Individual
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Provider Name | FRED WAYNE WALKER LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1150 RED JOHN DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32124-1016
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Country | US
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Telephone | 386-236-1739
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Fax | 386-239-6675
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Provider Business Mailing Address
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Address Line | 1350 ALMOND ST
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City | ORANGE CITY
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State | FL
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Zip | 32763-3802
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Country | US
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Telephone | 386-774-2807
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Fax | 386-239-6675
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW7321
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License Number State | FL
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