Provider Demographics
NPI:1265632111
Name:WALKER, KENNETH ALLEN (CAMS, CPRP)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ALLEN
Last Name:WALKER
Suffix:
Gender:M
Credentials:CAMS, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 N MARTIN ST
Mailing Address - Street 2:BLDG #700
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6948
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:404-327-4028
Practice Address - Street 1:2675 N MARTIN ST
Practice Address - Street 2:BLDG #700
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6948
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-327-4028
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
172346OtherUSPRA/CPRP