Provider Demographics
NPI:1205160249
Name:WALTON, ANNE L (MC, LISAC, LAC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:L
Last Name:WALTON
Suffix:
Gender:F
Credentials:MC, LISAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 N CENTRAL AVE
Mailing Address - Street 2:SUITE 620
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1828
Mailing Address - Country:US
Mailing Address - Phone:602-279-5262
Mailing Address - Fax:602-279-5393
Practice Address - Street 1:4520 N CENTRAL AVE
Practice Address - Street 2:SUITE 620
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1828
Practice Address - Country:US
Practice Address - Phone:602-279-5262
Practice Address - Fax:602-279-5393
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 11366101YA0400X
AZLAC 12816101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)