MEDICARE: VIRGIL WALKER MA, LPC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1407675804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGIL WALKER MA, LPC

Provider Business Mailing Address
First Line	:	200 OLD MILL RD APT 209
Second Line	:
City	:	OAKDALE
State	:	PA
Zip	:	15071-3867
Country	:	US
Telephone Number	:	330-348-1055
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-7301
Country	:	US
Telephone Number	:	323-205-7088
Fax Number	:

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

Provider Enumeration Date	:	10/03/2024
Last Update Date	:	10/14/2024

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