Provider Demographics
NPI:1750948832
Name:WALTON, CANDANCE YOLANDA (MSW)
Entity type:Individual
Prefix:MS
First Name:CANDANCE
Middle Name:YOLANDA
Last Name:WALTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 KINGS FORK RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-7151
Mailing Address - Country:US
Mailing Address - Phone:757-903-3014
Mailing Address - Fax:
Practice Address - Street 1:351 KINGS FORK RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-7151
Practice Address - Country:US
Practice Address - Phone:757-923-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-06037251041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool