Provider Demographics
NPI:1023460912
Name:WALSTON HEALTH SERVICES LLC
Entity type:Organization
Organization Name:WALSTON HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-924-9810
Mailing Address - Street 1:6164 FULLER CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2540
Mailing Address - Country:US
Mailing Address - Phone:703-924-9810
Mailing Address - Fax:703-924-7044
Practice Address - Street 1:6164 FULLER CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2540
Practice Address - Country:US
Practice Address - Phone:703-924-9810
Practice Address - Fax:703-924-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173415261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)