Provider Demographics
NPI:1912125584
Name:WALKER, CAROL JO (MA)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JO
Last Name:WALKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 HAMPSHIRE RD
Mailing Address - Street 2:STE. 215
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2379
Mailing Address - Country:US
Mailing Address - Phone:805-371-4794
Mailing Address - Fax:805-371-4875
Practice Address - Street 1:699 HAMPSHIRE RD
Practice Address - Street 2:STE. 215
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2379
Practice Address - Country:US
Practice Address - Phone:805-371-4794
Practice Address - Fax:805-371-4875
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 23254106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist