Provider Demographics
NPI:1952570780
Name:WALKER, KARYETTA L (EDD, LCMHC)
Entity Type:Individual
Prefix:DR
First Name:KARYETTA
Middle Name:L
Last Name:WALKER
Suffix:
Gender:F
Credentials:EDD, LCMHC
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Mailing Address - Street 1:125 TRADE COURT
Mailing Address - Street 2:SUITE F PMB 1001
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5546
Mailing Address - Country:US
Mailing Address - Phone:336-965-7362
Mailing Address - Fax:704-662-0106
Practice Address - Street 1:109 WOODSONG LN STE B
Practice Address - Street 2:VIRTUAL ADDRESS
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8007
Practice Address - Country:US
Practice Address - Phone:336-965-7362
Practice Address - Fax:704-498-0682
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC6879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104322Medicaid