Provider Demographics
NPI:1679230924
Name:WALKENFORD, JENNIFER (LAC-CCS, NCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WALKENFORD
Suffix:
Gender:F
Credentials:LAC-CCS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N NEW HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2830
Mailing Address - Country:US
Mailing Address - Phone:985-893-6113
Mailing Address - Fax:985-893-2648
Practice Address - Street 1:430 N NEW HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2830
Practice Address - Country:US
Practice Address - Phone:985-893-6113
Practice Address - Fax:985-893-2648
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5029101YA0400X
LALAC-5029101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)