Provider Demographics
NPI:1265559967
Name:WALKER, REGINALD B (LPC)
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:B
Last Name:WALKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 DEAN CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-4904
Mailing Address - Country:US
Mailing Address - Phone:334-774-6181
Mailing Address - Fax:
Practice Address - Street 1:2861 NEAL METCALF RD
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-8003
Practice Address - Country:US
Practice Address - Phone:334-347-0212
Practice Address - Fax:334-347-9418
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL62-41242OtherALL KIDS PLUS
AL62-31242OtherALL KIDS UBH