Provider Demographics
NPI:1619300605
Name:WALKER, LISA (LCPC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5401 RAPIDAN CT
Mailing Address - Street 2:
Mailing Address - City:LOTHIAN
Mailing Address - State:MD
Mailing Address - Zip Code:20711-5724
Mailing Address - Country:US
Mailing Address - Phone:708-906-0205
Mailing Address - Fax:
Practice Address - Street 1:20200 GOVERNORS DR
Practice Address - Street 2:107
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1032
Practice Address - Country:US
Practice Address - Phone:708-906-0205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008731101YA0400X, 101YP2500X, 101YM0800X
MDLC11094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional