Provider Demographics
NPI:1003517517
Name:WALTON, VIRGINIA MAE (MSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MAE
Last Name:WALTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 S JASMINE ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1525
Mailing Address - Country:US
Mailing Address - Phone:720-320-4343
Mailing Address - Fax:
Practice Address - Street 1:6021 S SYRACUSE WAY STE 111
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4746
Practice Address - Country:US
Practice Address - Phone:720-320-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0105568106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist