Provider Demographics
NPI:1114224342
Name:WALKER, MANDY N
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:N
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 ORANGEBURG RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-8914
Mailing Address - Country:US
Mailing Address - Phone:843-261-2600
Mailing Address - Fax:888-839-6837
Practice Address - Street 1:679 ORANGEBURG RD
Practice Address - Street 2:SUITE F
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-8914
Practice Address - Country:US
Practice Address - Phone:843-261-2600
Practice Address - Fax:888-839-6837
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor