Provider Demographics
NPI:1427073618
Name:WALKER, ROSLYN MILLER (MA, LPA)
Entity type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:MILLER
Last Name:WALKER
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 J N PEASE PL STE 204
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4543
Mailing Address - Country:US
Mailing Address - Phone:704-717-2800
Mailing Address - Fax:704-717-2440
Practice Address - Street 1:1931 J N PEASE PL STE 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4543
Practice Address - Country:US
Practice Address - Phone:704-717-2800
Practice Address - Fax:704-717-6200
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1526103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107329Medicaid
NC144PEOtherBLUE CROSS BLUE SHIED