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NPI Code Detail

MEDICARE: DOMINIQUE WALKER

MEDICARE: DOMINIQUE WALKER
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
1101YM0800XMental Health CounselorLA

General Provider Information

NPI Number : 1700243060
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIQUE WALKER
Provider Business Mailing Address
First Line : 914 SAMUEL THOMAS ST
Second Line :
City : RAYNE
State : LA
Zip : 70578-2017
Country : US
Telephone Number : 337-849-9400
Fax Number : 337-232-9459
Provider Business Practice Location Address
First Line : 1010 AUBURN AVE
Second Line :
City : LAFAYETTE
State : LA
Zip : 70503-2308
Country : US
Telephone Number : 337-232-9457
Fax Number : 337-232-9459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2016
Last Update Date : 01/18/2016

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Directions to “ DOMINIQUE WALKER ” Practice Location

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