Provider Demographics
NPI:1851004394
Name:WALKER, SAMUEL (LLCP)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:LLCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4149 JAYDEN CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-4419
Mailing Address - Country:US
Mailing Address - Phone:248-895-0975
Mailing Address - Fax:
Practice Address - Street 1:4149 JAYDEN CT
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-4419
Practice Address - Country:US
Practice Address - Phone:248-895-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty