Provider Demographics
NPI:1528509429
Name:WALKER, KATRINA (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 HOWARD LN
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8506
Mailing Address - Country:US
Mailing Address - Phone:803-465-2196
Mailing Address - Fax:
Practice Address - Street 1:164 HOWARD LN
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8506
Practice Address - Country:US
Practice Address - Phone:803-465-2196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000858103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0133000858OtherLICENSED BEHAVIOR ANALYST
1-16-23558OtherBOARD CERTIFIED BEHAVIOR ANALYST