Provider Demographics
NPI:1730360900
Name:WALKER, LIESTA R (PC)
Entity type:Individual
Prefix:
First Name:LIESTA
Middle Name:R
Last Name:WALKER
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 HICKORY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-9710
Mailing Address - Country:US
Mailing Address - Phone:740-452-1475
Mailing Address - Fax:
Practice Address - Street 1:534 MARKET ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3651
Practice Address - Country:US
Practice Address - Phone:740-452-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0600601101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor