Provider Demographics
NPI:1770053027
Name:WALKER, M'KYLA (LCSW-A)
Entity type:Individual
Prefix:
First Name:M'KYLA
Middle Name:
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 1:250 N TRADE ST STE 206
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-9433
Mailing Address - Country:US
Mailing Address - Phone:980-202-2288
Mailing Address - Fax:980-280-1543
Practice Address - Street 1:380 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2402
Practice Address - Country:US
Practice Address - Phone:704-403-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2024-09-27
Deactivation Date:2021-10-19
Deactivation Code:
Reactivation Date:2021-10-28
Provider Licenses
StateLicense IDTaxonomies
NCP0169791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC82-2450083OtherLA VIDA COUNSELING, PLLC