Provider Demographics
NPI:1174589964
Name:WALKER-MATTHEWS, SUSAN GRACE (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GRACE
Last Name:WALKER-MATTHEWS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-9769
Mailing Address - Country:US
Mailing Address - Phone:304-727-0711
Mailing Address - Fax:
Practice Address - Street 1:FAMILY RESOURCE CENTER
Practice Address - Street 2:800 PENNSYLVANIA AVE.
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302
Practice Address - Country:US
Practice Address - Phone:304-388-2771
Practice Address - Fax:304-388-2781
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV712103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical