MEDICARE: MRS. LATARSHA DORIS WALKER M.A.LCPC

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	LC1957	MD

General Provider Information

NPI Number	:	1770772279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LATARSHA DORIS WALKER M.A.LCPC

Provider Business Mailing Address
First Line	:	7704 STARSHINE DR
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-1895
Country	:	US
Telephone Number	:	301-336-2452
Fax Number	:

Provider Business Practice Location Address
First Line	:	7704 STARSHINE DR
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-1895
Country	:	US
Telephone Number	:	301-336-2452
Fax Number	:

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

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	04/09/2008

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