Provider Demographics
NPI:1962995308
Name:WALKER, GENE AUTRY JR (CDCA)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:AUTRY
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CHRISTOPHER AVE APT B
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-7366
Mailing Address - Country:US
Mailing Address - Phone:724-480-8290
Mailing Address - Fax:
Practice Address - Street 1:401 MARKET ST
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2881
Practice Address - Country:US
Practice Address - Phone:740-314-5339
Practice Address - Fax:740-314-5527
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.162840101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0210495Medicaid