Provider Demographics
NPI:1720147937
Name:WALTON, SCOTT MATTHEW (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MATTHEW
Last Name:WALTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 BONNER DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-8948
Mailing Address - Country:US
Mailing Address - Phone:336-889-6105
Mailing Address - Fax:336-387-9167
Practice Address - Street 1:902 BONNER DR
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-8948
Practice Address - Country:US
Practice Address - Phone:336-889-6105
Practice Address - Fax:336-387-9167
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0051261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC144POOtherBLUE CROSS BLUE SHIELD
NC6106308Medicaid
P00377636Medicare PIN
2874245AMedicare PIN