Provider Demographics
NPI:1417076134
Name:WALKER, GLENDALE ELIZABETH (LPC,CADC,CAC,CCDP)
Entity Type:Individual
Prefix:MS
First Name:GLENDALE
Middle Name:ELIZABETH
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPC,CADC,CAC,CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 STENTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-2004
Mailing Address - Country:US
Mailing Address - Phone:215-927-1196
Mailing Address - Fax:
Practice Address - Street 1:1600 STENTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2004
Practice Address - Country:US
Practice Address - Phone:215-927-1196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003797101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9599OtherINTERNATIONAL. ADDICT. CO
NJ0041530Medicaid
DE566OtherCERT.ADDICTION COUNSELOR
PAPC003797OtherLICENSE PROFESS. COUNSELO
PA2045OtherADDICTIOND COUNSELOR
PA6100OtherCOOCURRING DISORDER PROFE