1780855049 NPI number — FELICIA WALKER CASE MANAGER

Table of content: FELICIA WALKER CASE MANAGER (NPI 1780855049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780855049 NPI number — FELICIA WALKER CASE MANAGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
FELICIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CASE MANAGER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780855049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
841 JIMMY ANN DRIVE
Provider Second Line Business Mailing Address:
HALIFAX BEHAVIORAL SERVICES
Provider Business Mailing Address City Name:
DAYTONA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32117-4583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-274-6646
Provider Business Mailing Address Fax Number:
386-226-0653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
841 JIMMY ANN DRIVE
Provider Second Line Business Practice Location Address:
HALIFAX BEHAVIORAL SERVICES
Provider Business Practice Location Address City Name:
DAYTONA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32117-4583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-274-6646
Provider Business Practice Location Address Fax Number:
386-226-0653
Provider Enumeration Date:
03/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 768995100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101062100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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