Individual
MS. KELLY D WALKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CIPS, CMHC
Contact information
Practice address
792 HIGHWAY 20, YOUNGSTOWN, FL 32466-3517
(850) 743-9978
Mailing address
792 HIGHWAY 20, YOUNGSTOWN, FL 32466-3517
(850) 743-9978
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
36-89142
FL
101YA0400X
Addiction (Substance Use Disorder) Counselor
319062
FL
101YM0800X
Mental Health Counselor
517068
FL
146D00000X
Personal Emergency Response Attendant
0090HTG
FL
172V00000X
Community Health Worker
590116
FL
405300000X
Prevention Professional
379114
FL
Other
Enumeration date
06/13/2020
Last updated
03/30/2021
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