Provider Demographics
NPI:1598457186
Name:WALKER, TANYA SUE (ALC, NCC, CAC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:SUE
Last Name:WALKER
Suffix:
Gender:F
Credentials:ALC, NCC, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:SUMITON
Mailing Address - State:AL
Mailing Address - Zip Code:35148-3339
Mailing Address - Country:US
Mailing Address - Phone:205-505-9392
Mailing Address - Fax:
Practice Address - Street 1:1713 6TH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0001
Practice Address - Country:US
Practice Address - Phone:205-505-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1252101YA0400X
ALALC04238101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)