Provider Demographics
NPI:1043986599
Name:WALKER, NAKEIYA SHANAE (RBT, MA)
Entity Type:Individual
Prefix:
First Name:NAKEIYA
Middle Name:SHANAE
Last Name:WALKER
Suffix:
Gender:F
Credentials:RBT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SPRING CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6225
Mailing Address - Country:US
Mailing Address - Phone:404-447-7560
Mailing Address - Fax:
Practice Address - Street 1:204 SPRING CIR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6225
Practice Address - Country:US
Practice Address - Phone:404-447-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-172406106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician