Provider Demographics
NPI:1326877853
Name:WALKER, ADAM (PRSS)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:CABIN CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25035-0309
Mailing Address - Country:US
Mailing Address - Phone:681-265-5090
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 309
Practice Address - Street 2:
Practice Address - City:CABIN CREEK
Practice Address - State:WV
Practice Address - Zip Code:25035-0309
Practice Address - Country:US
Practice Address - Phone:681-265-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WV24-988106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty