MEDICARE: DESTINEY CHARDONAY 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	0904012599	VA

General Provider Information

NPI Number	:	1558939447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINEY CHARDONAY WALKER LCSW

Provider Business Mailing Address
First Line	:	511 BAINBRIDGE ST APT 175B
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-2378
Country	:	US
Telephone Number	:	804-551-0796
Fax Number	:

Provider Business Practice Location Address
First Line	:	7834 FOREST HILL AVE STE 5
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1974
Country	:	US
Telephone Number	:	804-551-0796
Fax Number	:

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

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	06/16/2021

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