Provider Demographics
NPI:1811502974
Name:WALKER, CHERYL D
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:D
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 NORTHSIDE DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2672
Mailing Address - Country:US
Mailing Address - Phone:734-320-2501
Mailing Address - Fax:
Practice Address - Street 1:2801 BUFORD HWY NE STE 195
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2124
Practice Address - Country:US
Practice Address - Phone:770-284-1044
Practice Address - Fax:404-228-3860
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty