Provider Demographics
NPI:1861890923
Name:WALKER, LEE
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:A
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:33 ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:CARNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30521-3669
Mailing Address - Country:US
Mailing Address - Phone:706-340-7395
Mailing Address - Fax:
Practice Address - Street 1:33 ATHENS ST
Practice Address - Street 2:
Practice Address - City:CARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30521-3669
Practice Address - Country:US
Practice Address - Phone:706-340-7395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC53241041C0700X
GACSW0016451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical