Provider Demographics
NPI:1770907727
Name:WALKER, KENYATTA DENISE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KENYATTA
Middle Name:DENISE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 SINCLAIR WAY
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-7962
Mailing Address - Country:US
Mailing Address - Phone:678-516-5179
Mailing Address - Fax:
Practice Address - Street 1:1435 N EXPRESSWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-9016
Practice Address - Country:US
Practice Address - Phone:678-516-5179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0050421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical