Provider Demographics
NPI:1467819177
Name:WALKER, CALVIN DETRICK SR (MA, LPCA)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:DETRICK
Last Name:WALKER
Suffix:SR
Gender:M
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 CRANDON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2790
Mailing Address - Country:US
Mailing Address - Phone:704-533-5312
Mailing Address - Fax:
Practice Address - Street 1:119 WEST AVE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-4332
Practice Address - Country:US
Practice Address - Phone:704-630-6634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11880101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty