NPI 1366203077

Samuel Walker, PCCSSS

Practitioner Peer Specialist Gulfport, MS

Practice location

Address: 1600 Broad Ave, Gulfport, MS 39501-3603
Phone: (228) 213-5888
Fax: (228) 575-3433
Mailing address: PO Box 18679, Hattiesburg, MS 39404-8679

Registered specialties

Peer Specialist Primary

Other Service Providers Taxonomy 175T00000X Licence 4138 (MS)

Other Peer Specialist providers in Mississippi →

Registry record

NPI: 1366203077
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Jan 2024
Record last updated: 19 Jan 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.