Provider Demographics
NPI:1760720486
Name:WALKER, JENNIFER E (MHP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:WALKER
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 SAINT JAMES AVE STE L-167
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2768
Mailing Address - Country:US
Mailing Address - Phone:843-619-7892
Mailing Address - Fax:
Practice Address - Street 1:105 CENTRAL AVE STE 200-B
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3084
Practice Address - Country:US
Practice Address - Phone:843-619-7892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
SCSC-7199101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid