Provider Demographics
NPI:1093843864
Name:WALKER, RICHARD DAVIS JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DAVIS
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WHITE OAK LANE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35633
Mailing Address - Country:US
Mailing Address - Phone:256-760-1164
Mailing Address - Fax:
Practice Address - Street 1:1090 OLD FLORENCE ROAD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:37454
Practice Address - Country:US
Practice Address - Phone:931-762-6505
Practice Address - Fax:931-762-3690
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35021041C0700X
AL0046C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3698406Medicaid
TN3698406Medicaid