Provider Demographics
NPI:1912107582
Name:WALTON, JENNIFER (MA)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 GREENSPIRE WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2715
Mailing Address - Country:US
Mailing Address - Phone:718-757-2364
Mailing Address - Fax:
Practice Address - Street 1:2635 RIVA RD
Practice Address - Street 2:SUITE 108
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7430
Practice Address - Country:US
Practice Address - Phone:410-573-9000
Practice Address - Fax:410-573-9001
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health