Provider Demographics
NPI:1366853608
Name:WALKER, DEMENICO
Entity Type:Individual
Prefix:
First Name:DEMENICO
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2006
Mailing Address - Country:US
Mailing Address - Phone:864-582-5431
Mailing Address - Fax:864-582-7111
Practice Address - Street 1:1530 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2006
Practice Address - Country:US
Practice Address - Phone:864-582-5431
Practice Address - Fax:864-582-7111
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1851613186OtherREHAB CENTER