Provider Demographics
NPI:1568547081
Name:WALKER, GORDON R JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:R
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:804 MOOREFIELD PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3670
Mailing Address - Country:US
Mailing Address - Phone:804-560-4640
Mailing Address - Fax:804-560-4813
Practice Address - Street 1:804 MOOREFIELD PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3670
Practice Address - Country:US
Practice Address - Phone:804-560-4640
Practice Address - Fax:804-560-4813
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00159187OtherRAILROAD MEDICARE
VA085796OtherSENTARA
VA007730624Medicaid
VA090961OtherANTHEM
VA090944OtherANTHEM F&A
VAP00159187OtherRAILROAD MEDICARE