Provider Demographics
NPI:1417468059
Name:WALKER, DEIDRA ANN (LCSWA)
Entity Type:Individual
Prefix:
First Name:DEIDRA
Middle Name:ANN
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:MRS
Other - First Name:DEIDRA
Other - Middle Name:A
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DEIDRA MATHEWSON
Mailing Address - Street 1:1121 STERLING GREEN DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7954
Mailing Address - Country:US
Mailing Address - Phone:330-475-5513
Mailing Address - Fax:
Practice Address - Street 1:1121 STERLING GREEN DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-7954
Practice Address - Country:US
Practice Address - Phone:330-475-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO107971041C0700X
NCP0107971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical