Provider Demographics
NPI:1821769688
Name:WALKER, BRENDA MARIE (LADAC, CCS, CADC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LADAC, CCS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5207 HALIFAX DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-2840
Mailing Address - Country:US
Mailing Address - Phone:501-703-3939
Mailing Address - Fax:
Practice Address - Street 1:5207 HALIFAX DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-2840
Practice Address - Country:US
Practice Address - Phone:501-703-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 251B00000X
AR397L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251B00000XAgenciesCase Management