Provider Demographics
NPI:1912108838
Name:NEUROLIFE, LLC
Entity Type:Organization
Organization Name:NEUROLIFE, LLC
Other - Org Name:CAROL WALKER, PHD, ABPP, CLCP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP, CLCP
Authorized Official - Phone:256-535-2322
Mailing Address - Street 1:1428 WEATHERLY RD SE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-1181
Mailing Address - Country:US
Mailing Address - Phone:256-535-2322
Mailing Address - Fax:256-650-5909
Practice Address - Street 1:7501 MEMORIAL PKWY SW
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2204
Practice Address - Country:US
Practice Address - Phone:256-535-2322
Practice Address - Fax:256-650-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL619103G00000X, 103TC0700X, 103TF0200X, 103TH0100X, 103TR0400X
GAPSY002462103G00000X, 103TC0700X, 103TF0200X, 103TH0100X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty