Provider Demographics
NPI:1851808893
Name:WALKER, CORI L (LCSW)
Entity Type:Individual
Prefix:
First Name:CORI
Middle Name:L
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 1:3427 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3039
Mailing Address - Country:US
Mailing Address - Phone:888-464-1811
Mailing Address - Fax:800-416-3070
Practice Address - Street 1:3427 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3039
Practice Address - Country:US
Practice Address - Phone:888-464-1811
Practice Address - Fax:800-416-3070
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC84381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical