Provider Demographics
NPI:1972864890
Name:WALTON, PAMELA DIONNE (LPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DIONNE
Last Name:WALTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5853 STRATHMOOR MANOR CIR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-2620
Mailing Address - Country:US
Mailing Address - Phone:678-382-8567
Mailing Address - Fax:
Practice Address - Street 1:5853 STRATHMOOR MANOR CIR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-2620
Practice Address - Country:US
Practice Address - Phone:678-382-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002837101YP2500X
GALPC007478101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional