Provider Demographics
NPI:1366467268
Name:WALKER, MICHELE L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:L
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:L
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2402 NORTH TIFT AVE.
Mailing Address - Street 2:STE. 102 SOUTH GEORGIA PSYCHIATRIC AND COUNSELING CENTE
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794
Mailing Address - Country:US
Mailing Address - Phone:229-387-8878
Mailing Address - Fax:229-387-8881
Practice Address - Street 1:2402 NORTH TIFT AVE.
Practice Address - Street 2:STE. 102 SOUTH GEORGIA PSYCHIATRIC AND COUNSELING CENTE
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794
Practice Address - Country:US
Practice Address - Phone:229-387-8878
Practice Address - Fax:229-387-8881
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0032671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA348879000OtherMAGELLAN HEALTH SERVICES
GA764550927A, B, C, DMedicaid
GA52072002-01OtherBLUE CROSS/BLUE SHEILD
GA348879000OtherMAGELLAN HEALTH SERVICES
GA764550927A, B, C, DMedicaid