Provider Demographics
NPI:1578789053
Name:WALKER-GRIFFIN, TILWANA (LCPC)
Entity Type:Individual
Prefix:
First Name:TILWANA
Middle Name:
Last Name:WALKER-GRIFFIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 CLENDENIN ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3516
Mailing Address - Country:US
Mailing Address - Phone:443-838-1166
Mailing Address - Fax:
Practice Address - Street 1:1108 CLENDENIN ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3516
Practice Address - Country:US
Practice Address - Phone:443-838-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00227990Medicaid