Provider Demographics
NPI:1891501672
Name:WALKER, MATALIE
Entity type:Individual
Prefix:
First Name:MATALIE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5896 FLETCHER RD
Mailing Address - Street 2:
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-3250
Mailing Address - Country:US
Mailing Address - Phone:205-276-6864
Mailing Address - Fax:
Practice Address - Street 1:208 JEFFERSON AVENUE
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020
Practice Address - Country:US
Practice Address - Phone:205-276-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17136101YA0400X, 101YM0800X, 101YP1600X
171400000X
AL347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171400000XOther Service ProvidersHealth & Wellness Coach
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No347C00000XTransportation ServicesPrivate Vehicle