Provider Demographics
NPI:1154174498
Name:WALKER, JOSEPH WAYNE (JD, LCMHCA, MA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WAYNE
Last Name:WALKER
Suffix:
Gender:M
Credentials:JD, LCMHCA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8145 ARDREY KELL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-5721
Mailing Address - Country:US
Mailing Address - Phone:704-776-3238
Mailing Address - Fax:
Practice Address - Street 1:8145 ARDREY KELL RD STE 206
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5721
Practice Address - Country:US
Practice Address - Phone:704-776-3238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health