Provider Demographics
NPI:1669672978
Name:WALKER, MICHELLE NICOLE (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NICOLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9707 KEY WEST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3992
Mailing Address - Country:US
Mailing Address - Phone:240-750-6467
Mailing Address - Fax:240-702-0262
Practice Address - Street 1:9707 KEY WEST AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3992
Practice Address - Country:US
Practice Address - Phone:240-750-6467
Practice Address - Fax:240-702-0262
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25670103T00000X
MD06191103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD06191OtherPSYCHOLOGIST LICENSE
CA25670OtherLIC