Provider Demographics
NPI:1154337160
Name:WALKER, KENNETH GAMALIEL SR (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:GAMALIEL
Last Name:WALKER
Suffix:SR
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 BOULDER PARK DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-1805
Mailing Address - Country:US
Mailing Address - Phone:404-375-7744
Mailing Address - Fax:404-691-2377
Practice Address - Street 1:1230 HIGHTOWER RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3822
Practice Address - Country:US
Practice Address - Phone:404-375-7744
Practice Address - Fax:404-794-0151
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000404101YM0800X
GA000571106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist