Provider Demographics
NPI:1235470733
Name:WALKER, PAUL JR (PHD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 POTTERS RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4324
Mailing Address - Country:US
Mailing Address - Phone:757-498-9391
Mailing Address - Fax:757-498-7073
Practice Address - Street 1:2580 POTTERS RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4324
Practice Address - Country:US
Practice Address - Phone:757-498-9391
Practice Address - Fax:757-498-7073
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA081004740103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical