Active NPI
Ebony Glynn Walker, LPC
- Professional Counselor
- Petersburg, VA
National Provider Identifier
1093329385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0701009893
- Practice address
- 350 Poplar Dr
Petersburg, VA 23805-9367 - Phone
- (804) 733-6874
- NPI assigned
- Sep 3, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701009893 | VA | Primary |
Addresses
Primary practice location
350 Poplar Dr
Petersburg, VA 23805-9367
Mailing address
9482 W Brightway Cir
Henrico, VA 23294-5564
Phone (804) 937-5254
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0701009893 | VA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599091200000",
"number": "1093329385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9482 W BRIGHTWAY CIR",
"city": "HENRICO",
"state": "VA",
"postal_code": "232945564",
"telephone_number": "804-937-5254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 POPLAR DR",
"city": "PETERSBURG",
"state": "VA",
"postal_code": "238059367",
"telephone_number": "804-733-6874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALKER",
"first_name": "EBONY",
"middle_name": "GLYNN",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-03",
"last_updated": "2020-09-03",
"certification_date": "2020-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "VA",
"license": "0701009893",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petersburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.