Provider Demographics
NPI:1790806768
Name:WALKER, TANIA M (LCSW)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 VAUXHALL DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4155
Mailing Address - Country:US
Mailing Address - Phone:919-210-5930
Mailing Address - Fax:
Practice Address - Street 1:220 SNOW AVE
Practice Address - Street 2:CO CORNERSTONE
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1535
Practice Address - Country:US
Practice Address - Phone:919-857-3764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2016-04-27
Deactivation Date:2015-01-28
Deactivation Code:
Reactivation Date:2016-04-27
Provider Licenses
StateLicense IDTaxonomies
NCC0045071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical