Provider Demographics
NPI:1568772515
Name:WALKER, STACEY RENEE (LGSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:RENEE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:RENEE
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:200 E VINE ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5531
Mailing Address - Country:US
Mailing Address - Phone:410-543-7181
Mailing Address - Fax:410-543-7186
Practice Address - Street 1:200 E VINE ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5531
Practice Address - Country:US
Practice Address - Phone:410-543-7181
Practice Address - Fax:410-543-7186
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 104100000X
MD194101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609550004Medicaid
MD609500300Medicaid