Provider Demographics
NPI:1386318046
Name:WALKER, AVERY CARTER CARTER (PSYD)
Entity type:Individual
Prefix:DR
First Name:AVERY CARTER
Middle Name:CARTER
Last Name:WALKER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 BERRYESSA ROAD, UNIT 436
Mailing Address - Street 2:MAILBOX NO. 253
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133
Mailing Address - Country:US
Mailing Address - Phone:917-870-8255
Mailing Address - Fax:
Practice Address - Street 1:248 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3074
Practice Address - Country:US
Practice Address - Phone:650-839-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor