Provider Demographics
NPI:1114755873
Name:WALKER, KATHERINE LANTOW (MS, LCASA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LANTOW
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 ATTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-8436
Mailing Address - Country:US
Mailing Address - Phone:919-412-8965
Mailing Address - Fax:
Practice Address - Street 1:6124 SAINT GILES ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7042
Practice Address - Country:US
Practice Address - Phone:919-412-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20542101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health