Provider Demographics
NPI:1275899692
Name:WALKER, GEORGE MCGWAINE (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MCGWAINE
Last Name:WALKER
Suffix:
Gender:M
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 MICHAEL RD APT D
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-2453
Mailing Address - Country:US
Mailing Address - Phone:561-702-9788
Mailing Address - Fax:
Practice Address - Street 1:78 MICHAEL RD APT D
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-2453
Practice Address - Country:US
Practice Address - Phone:561-702-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002095101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4553929OtherAETNA
CT004121141Medicaid
CT321137/A324839OtherVALUE OPTIONS
CT201366OtherMHN
A412956OtherOXFORD