Provider Demographics
NPI:1528058294
Name:WALKER, CAROLE GAY (MFT)
Entity type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:GAY
Last Name:WALKER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:GAY
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:2701 MACDOUGAL ST
Mailing Address - Street 2:#13
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-2355
Mailing Address - Country:US
Mailing Address - Phone:209-524-5105
Mailing Address - Fax:209-524-5105
Practice Address - Street 1:2701 MACDOUGAL ST
Practice Address - Street 2:APT. 13
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2355
Practice Address - Country:US
Practice Address - Phone:209-524-5105
Practice Address - Fax:209-524-5105
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28792106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist