Provider Demographics
NPI:1922021468
Name:WALKER, LOLA GORMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOLA
Middle Name:GORMAN
Last Name:WALKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5777 W CENTURY BLVD
Mailing Address - Street 2:SUITE 1645 E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5600
Mailing Address - Country:US
Mailing Address - Phone:310-649-3651
Mailing Address - Fax:310-649-3982
Practice Address - Street 1:5777 W CENTURY BLVD
Practice Address - Street 2:SUITE 1645 E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5600
Practice Address - Country:US
Practice Address - Phone:310-649-3651
Practice Address - Fax:310-649-3982
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13953103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954727290OtherTIN