Provider Demographics
NPI:1023601564
Name:WALKER-PHILLIPS, VIKITA D (LMSW)
Entity type:Individual
Prefix:
First Name:VIKITA
Middle Name:D
Last Name:WALKER-PHILLIPS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:VIKITA
Other - Middle Name:D
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3640 MIDDLEBURY DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-5431
Mailing Address - Country:US
Mailing Address - Phone:269-998-6377
Mailing Address - Fax:
Practice Address - Street 1:451 HEALTH PKWY STE B
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-8242
Practice Address - Country:US
Practice Address - Phone:269-655-3065
Practice Address - Fax:269-655-0585
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010872371041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker