MEDICARE: MRS. EBONIE L. WALKER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904006451	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2659993	OTHER	VA	CIGNA BEHAVIORAL
2	000398195	OTHER	VA	UNITED BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1053590109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EBONIE L. WALKER LCSW

Provider Business Mailing Address
First Line	:	PO BOX 13296
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23325-0296
Country	:	US
Telephone Number	:	757-714-1838
Fax Number	:	757-321-6269

Provider Business Practice Location Address
First Line	:	4605 PEMBROKE LAKE CIR STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6436
Country	:	US
Telephone Number	:	757-395-7237
Fax Number	:	757-321-6269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	11/28/2009

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