Provider Demographics
NPI:1790849420
Name:WALKER, ANITRA PETEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANITRA
Middle Name:PETEN
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 1:4334 MOONGLOW TRL
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4190
Mailing Address - Country:US
Mailing Address - Phone:678-471-0228
Mailing Address - Fax:
Practice Address - Street 1:3675 CRESTWOOD PKWY NW
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1805
Practice Address - Country:US
Practice Address - Phone:678-471-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3381101YM0800X
GACSW0038991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health