Provider Demographics
NPI:1639905730
Name:WALKER, SAMANTHA SUSAN (LPC-A)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SUSAN
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:SUSAN
Other - Last Name:ROHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 PARK MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3340
Mailing Address - Country:US
Mailing Address - Phone:817-271-5163
Mailing Address - Fax:
Practice Address - Street 1:4125 FAIRWAY DR STE 130
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4161
Practice Address - Country:US
Practice Address - Phone:972-885-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health