Provider Demographics
NPI:1093393761
Name:WALKER, QUITEYA DAWN (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:QUITEYA
Middle Name:DAWN
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1572
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27285-1572
Mailing Address - Country:US
Mailing Address - Phone:843-514-2431
Mailing Address - Fax:
Practice Address - Street 1:3760 THORNDKE CIR
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1996
Practice Address - Country:US
Practice Address - Phone:843-514-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15401101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health