Provider Demographics
NPI:1780994053
Name:WALKER, JANIQUE WASHINGTON (LPC)
Entity type:Individual
Prefix:DR
First Name:JANIQUE
Middle Name:WASHINGTON
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:JANIQUE
Other - Middle Name:WASHINGTON
Other - Last Name:SMALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:180 ABBEY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT WOLF
Mailing Address - State:PA
Mailing Address - Zip Code:17347-9516
Mailing Address - Country:US
Mailing Address - Phone:336-456-2677
Mailing Address - Fax:336-217-8384
Practice Address - Street 1:180 ABBEY DR
Practice Address - Street 2:
Practice Address - City:MOUNT WOLF
Practice Address - State:PA
Practice Address - Zip Code:17347-9516
Practice Address - Country:US
Practice Address - Phone:336-456-2677
Practice Address - Fax:336-217-8384
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104673Medicaid