Provider Demographics
NPI:1780855049
Name:WALKER, FELICIA (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 JIMMY ANN DRIVE
Mailing Address - Street 2:HALIFAX BEHAVIORAL SERVICES
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4583
Mailing Address - Country:US
Mailing Address - Phone:386-274-6646
Mailing Address - Fax:386-226-0653
Practice Address - Street 1:841 JIMMY ANN DRIVE
Practice Address - Street 2:HALIFAX BEHAVIORAL SERVICES
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4583
Practice Address - Country:US
Practice Address - Phone:386-274-6646
Practice Address - Fax:386-226-0653
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768995100Medicaid