Provider Demographics
NPI:1922180298
Name:WALKER, JAMES GIBBONS (LCSW-C, ACSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GIBBONS
Last Name:WALKER
Suffix:
Gender:M
Credentials:LCSW-C, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10123 SENATE DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4367
Mailing Address - Country:US
Mailing Address - Phone:301-459-9840
Mailing Address - Fax:301-459-4856
Practice Address - Street 1:22 INDUSTRIAL PARK DR
Practice Address - Street 2:STE A
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2791
Practice Address - Country:US
Practice Address - Phone:301-638-7543
Practice Address - Fax:301-638-9992
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL26461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR103067Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER