Provider Demographics
NPI:1942432513
Name:WALKER, PETER (MA, LCAS)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:MA, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 BLUE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4652
Mailing Address - Country:US
Mailing Address - Phone:919-573-6520
Mailing Address - Fax:919-573-6557
Practice Address - Street 1:4112 BLUE RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4652
Practice Address - Country:US
Practice Address - Phone:919-573-6520
Practice Address - Fax:919-573-6557
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1497101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)