Provider Demographics
NPI:1639236474
Name:WALTON, MARIA FAYE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:FAYE
Last Name:WALTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:FAYE
Other - Last Name:VAUGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW; PHD
Mailing Address - Street 1:1720 W END AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2612
Mailing Address - Country:US
Mailing Address - Phone:615-320-1155
Mailing Address - Fax:
Practice Address - Street 1:1720 W END AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2612
Practice Address - Country:US
Practice Address - Phone:615-320-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38871041C0700X
TN3244103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I801194Medicare PIN