Provider Demographics
NPI:1184747446
Name:WALKER, DELORES J (LCPC)
Entity type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:J
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339B RIVER RD.
Mailing Address - Street 2:#203
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:630-504-1504
Mailing Address - Fax:630-504-1504
Practice Address - Street 1:1172 DRIFTWOOD LN
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-5873
Practice Address - Country:US
Practice Address - Phone:630-289-6775
Practice Address - Fax:630-504-1504
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232275OtherPROVIDER