Basic Information
| Provider Information | |||||||||
| NPI: | 1952875239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVERETT WALKER | ||||||||
| FirstName: | GISELA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2148 WHITE EAGLE ST | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347148068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522423832 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2520 SAND MINE RD | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338973402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079102941 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2019 | ||||||||
| LastUpdateDate: | 01/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMH17947 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.