Provider Demographics
NPI:1598335796
Name:WALTON, BEVERLY LYNN (LCADC, CCS)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LYNN
Last Name:WALTON
Suffix:
Gender:F
Credentials:LCADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-3306
Mailing Address - Country:US
Mailing Address - Phone:267-393-3598
Mailing Address - Fax:
Practice Address - Street 1:3 3RD ST STE 20
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1370
Practice Address - Country:US
Practice Address - Phone:609-200-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00352000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1861557795Medicaid