Provider Demographics
NPI:1235605635
Name:WALTON, MELANIE KATHERINE (CDCA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:KATHERINE
Last Name:WALTON
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:KATHERINE
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA
Mailing Address - Street 1:1059 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1433
Mailing Address - Country:US
Mailing Address - Phone:937-335-4543
Mailing Address - Fax:937-339-8371
Practice Address - Street 1:1059 N MARKET ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1433
Practice Address - Country:US
Practice Address - Phone:937-335-4543
Practice Address - Fax:937-339-8371
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167848101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)