Provider Demographics
NPI:1730584004
Name:WALKER, AMANDA H (LCSWA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:H
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 TALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27020-7849
Mailing Address - Country:US
Mailing Address - Phone:336-466-0814
Mailing Address - Fax:
Practice Address - Street 1:4517 TALLEY RD
Practice Address - Street 2:
Practice Address - City:HAMPTONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27020-7849
Practice Address - Country:US
Practice Address - Phone:336-466-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0087031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical