Provider Demographics
NPI:1891043840
Name:TALK FAMILY OUTPATIENT
Entity Type:Organization
Organization Name:TALK FAMILY OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:757-248-8255
Mailing Address - Street 1:2117 SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23523-2436
Mailing Address - Country:US
Mailing Address - Phone:757-248-8255
Mailing Address - Fax:757-248-8256
Practice Address - Street 1:2117 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23523-2436
Practice Address - Country:US
Practice Address - Phone:757-248-8255
Practice Address - Fax:757-248-8256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty