Provider Demographics
NPI:1578211694
Name:WALKER, DELORA
Entity Type:Individual
Prefix:
First Name:DELORA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 N CHARLES ST FL 1
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-4645
Mailing Address - Country:US
Mailing Address - Phone:410-243-0458
Mailing Address - Fax:
Practice Address - Street 1:2512 N CHARLES ST FL 1
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4645
Practice Address - Country:US
Practice Address - Phone:410-243-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health