Provider Demographics
NPI:1063820967
Name:WALKER, KENNETH TYRONE (LPC, MS, MED)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:TYRONE
Last Name:WALKER
Suffix:
Gender:M
Credentials:LPC, MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 AUTUMN LEAF DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-4799
Mailing Address - Country:US
Mailing Address - Phone:478-294-9521
Mailing Address - Fax:229-352-5859
Practice Address - Street 1:127 AUTUMN LEAF DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-4799
Practice Address - Country:US
Practice Address - Phone:478-294-9521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional