Provider Demographics
NPI:1083958359
Name:EB-WALTON, RENEE ELISE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ELISE
Last Name:EB-WALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2341
Mailing Address - Country:US
Mailing Address - Phone:510-712-8788
Mailing Address - Fax:
Practice Address - Street 1:3837 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2419
Practice Address - Country:US
Practice Address - Phone:510-450-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)