Provider Demographics
NPI:1780651927
Name:WALKER, SANDRA LYNNE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYNNE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:1650 HWY 18 SOUTH
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-0159
Mailing Address - Country:US
Mailing Address - Phone:336-372-4095
Mailing Address - Fax:828-262-5687
Practice Address - Street 1:1650 HWY 18 SOUTH
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-9198
Practice Address - Country:US
Practice Address - Phone:336-372-4095
Practice Address - Fax:828-262-5687
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCN/AOtherCBHA
NC6102767Medicaid
NCN/AOtherMHNET
NC135PVOtherBCBS OF NC
NC2220029OtherCIGNA BEHAVIORAL HEALTH
NCD0753OtherMEDCOST