Provider Demographics
NPI:1134578685
Name:WALKER, MARLO DENISE (LCSW-A)
Entity type:Individual
Prefix:
First Name:MARLO
Middle Name:DENISE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 S KIRKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27801-6279
Mailing Address - Country:US
Mailing Address - Phone:719-761-1371
Mailing Address - Fax:
Practice Address - Street 1:730 ROANOKE AVE
Practice Address - Street 2:SUITE A1
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2743
Practice Address - Country:US
Practice Address - Phone:719-761-1371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0105071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical