Provider Demographics
NPI:1003520354
Name:WALTON, CHRISTIE L (CDC-A)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:L
Last Name:WALTON
Suffix:
Gender:F
Credentials:CDC-A
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:L
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:651 S LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1965
Mailing Address - Country:US
Mailing Address - Phone:937-324-1111
Mailing Address - Fax:937-525-4542
Practice Address - Street 1:651 S LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1965
Practice Address - Country:US
Practice Address - Phone:937-324-1111
Practice Address - Fax:373-287-2579
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.189297101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)