Provider Demographics
NPI:1750830428
Name:WALKER, BRENDA ANN (SOCIALWORKER)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:WALKER
Suffix:
Gender:F
Credentials:SOCIALWORKER
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:ANN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SOCIALWORKER
Mailing Address - Street 1:1302 VALPARAISO DRIVE APT J-14
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6199
Mailing Address - Country:US
Mailing Address - Phone:843-321-5282
Mailing Address - Fax:
Practice Address - Street 1:1302 VALPARAISO DR APT J14
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6199
Practice Address - Country:US
Practice Address - Phone:843-321-5282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9922104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker