Provider Demographics
NPI:1447395918
Name:WALKER, GERALD E (MA LCPC NCC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:E
Last Name:WALKER
Suffix:
Gender:M
Credentials:MA LCPC NCC
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:195 S 36TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-5801
Mailing Address - Country:US
Mailing Address - Phone:217-228-6194
Mailing Address - Fax:217-228-6194
Practice Address - Street 1:195 S 36TH ST
Practice Address - Street 2:STE 200
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-5801
Practice Address - Country:US
Practice Address - Phone:217-228-6194
Practice Address - Fax:217-228-6194
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004859101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor