Provider Demographics
NPI:1760910566
Name:WALKER, VICTORIA (MSPSY, BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MSPSY, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 AVONDALE LN NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1670
Mailing Address - Country:US
Mailing Address - Phone:330-685-3885
Mailing Address - Fax:330-319-8330
Practice Address - Street 1:4310 AVONDALE LN NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1670
Practice Address - Country:US
Practice Address - Phone:330-685-3885
Practice Address - Fax:330-319-8330
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-16-21404103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst