Provider Demographics
NPI:1417991506
Name:WALKER, JENNIFER GOSNELL (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GOSNELL
Last Name:WALKER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 DOCK ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4936
Mailing Address - Country:US
Mailing Address - Phone:910-254-9898
Mailing Address - Fax:910-254-9818
Practice Address - Street 1:5000 LAMBS PATH WAY
Practice Address - Street 2:THE YAHWEH CENTER CHILDREN'S VILLAGE
Practice Address - City:CASTLE HAYNE
Practice Address - State:NC
Practice Address - Zip Code:28429-6311
Practice Address - Country:US
Practice Address - Phone:910-675-3533
Practice Address - Fax:910-675-3405
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0028131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003767Medicaid
NC6003766Medicaid