Provider Demographics
NPI:1447234059
Name:WALKER, SUSAN (LADAC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 ALAMO AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3204
Mailing Address - Country:US
Mailing Address - Phone:505-925-2400
Mailing Address - Fax:505-925-2411
Practice Address - Street 1:2450 ALAMO AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3204
Practice Address - Country:US
Practice Address - Phone:505-925-2400
Practice Address - Fax:505-925-2411
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3576101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)