Provider Demographics
NPI:1477185924
Name:WALKER, KEHINDE (LPC)
Entity Type:Individual
Prefix:
First Name:KEHINDE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10302 ALMOND TREE CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-2798
Mailing Address - Country:US
Mailing Address - Phone:571-765-0057
Mailing Address - Fax:
Practice Address - Street 1:7350 HERITAGE VILLAGE PLZ UNIT 102
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3085
Practice Address - Country:US
Practice Address - Phone:571-765-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008756101YA0400X, 102X00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist