Provider Demographics
NPI:1093106106
Name:WALTON, SABRINA (LLPC)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLPC
Mailing Address - Street 1:19211 ANGLIN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1460
Mailing Address - Country:US
Mailing Address - Phone:313-400-0911
Mailing Address - Fax:
Practice Address - Street 1:19211 ANGLIN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1460
Practice Address - Country:US
Practice Address - Phone:313-400-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013615101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381459371Medicaid