Provider Demographics
NPI:1659807089
Name:WALKER, SHENIQUE (LCAS)
Entity Type:Individual
Prefix:
First Name:SHENIQUE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 SUNBOW FALLS LN
Mailing Address - Street 2:207
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8110
Mailing Address - Country:US
Mailing Address - Phone:252-702-3342
Mailing Address - Fax:
Practice Address - Street 1:1520 SUNBOW FALLS LN
Practice Address - Street 2:207
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8110
Practice Address - Country:US
Practice Address - Phone:252-702-3342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22272101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)