Provider Demographics
NPI:1194215103
Name:WALTON, DAYMOND CORTES (LPCC)
Entity Type:Individual
Prefix:
First Name:DAYMOND
Middle Name:CORTES
Last Name:WALTON
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 S 3RD ST APT 12B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-2165
Mailing Address - Country:US
Mailing Address - Phone:502-807-2708
Mailing Address - Fax:
Practice Address - Street 1:2210 GOLDSMITH LN STE 222
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1070
Practice Address - Country:US
Practice Address - Phone:502-245-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY241557101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY241557OtherLPCC