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Individual
KIP WALKER
Active
Individual
KIP WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
000375
VT
101YA0400X
Addiction (Substance Use Disorder) Counselor
000375
VT
101YM0800X
Mental Health Counselor
000375
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00069095
BLUE CROSS
VT
01
—
2196448
CIGNA
VT
Enumeration date
07/21/2006
Last updated
03/21/2008
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