Provider Demographics
NPI:1700641289
Name:WALTON, SECARRA DAVIDA
Entity Type:Individual
Prefix:
First Name:SECARRA
Middle Name:DAVIDA
Last Name:WALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 FOREST HURST GLN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-2401
Mailing Address - Country:US
Mailing Address - Phone:951-662-3543
Mailing Address - Fax:
Practice Address - Street 1:19702 NARVI CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-1475
Practice Address - Country:US
Practice Address - Phone:832-409-4417
Practice Address - Fax:833-320-8545
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YS0200X
TX88834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool