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General NPI Number Information
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NPI Number | 1568547081
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Entity Type | Individual
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Provider Name | GORDON R. WALKER JR. PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 804 MOOREFIELD PARK DR SUITE 201
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-3670
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Country | US
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Telephone | 804-560-4640
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Fax | 804-560-4813
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Provider Business Mailing Address
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Address Line | 804 MOOREFIELD PARK DR SUITE 201
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-3670
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Country | US
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Telephone | 804-560-4640
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Fax | 804-560-4813
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810002339
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License Number State | VA
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