Provider Demographics
NPI:1669296315
Name:WALTON, KEIANA (MA, LGPC)
Entity type:Individual
Prefix:
First Name:KEIANA
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:MA, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 E PAINTED WAY
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-8153
Mailing Address - Country:US
Mailing Address - Phone:216-288-1389
Mailing Address - Fax:
Practice Address - Street 1:372 E PAINTED WAY
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-8153
Practice Address - Country:US
Practice Address - Phone:216-288-1389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health