Provider Demographics
NPI:1700988722
Name:WALKER, MILES CLIFTON (M ED)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:CLIFTON
Last Name:WALKER
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 MCGEE RD
Mailing Address - Street 2:M CLIFTON WALKER
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-2104
Mailing Address - Country:US
Mailing Address - Phone:864-260-4168
Mailing Address - Fax:864-261-7543
Practice Address - Street 1:226 MCGEE RD
Practice Address - Street 2:M CLIFTON WALKER
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-2104
Practice Address - Country:US
Practice Address - Phone:864-260-4168
Practice Address - Fax:864-261-7543
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC1212192101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid
SC3333Medicare ID - Type Unspecified