Provider Demographics
NPI:1255582847
Name:BAILEY-WALKER, LOUISE (LPC)
Entity type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:
Last Name:BAILEY-WALKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6370 SHALLOWFORD WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-5428
Mailing Address - Country:US
Mailing Address - Phone:678-230-5831
Mailing Address - Fax:678-715-7235
Practice Address - Street 1:8317 OFFICE PARK DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6936
Practice Address - Country:US
Practice Address - Phone:678-230-5831
Practice Address - Fax:678-715-7235
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008633101YM0800X
GALPC004409101YP2500X
GA727875101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003124735BMedicaid
GA681635293CMedicaid