Provider Demographics
NPI:1952649881
Name:WALKER, JASON C (LPC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:WALKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S BROADWAY # 7
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-2235
Mailing Address - Country:US
Mailing Address - Phone:844-365-7676
Mailing Address - Fax:844-365-7676
Practice Address - Street 1:140 S BROADWAY # 7
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-2235
Practice Address - Country:US
Practice Address - Phone:844-365-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00466600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional