Healthcare Provider Details

I. General information

NPI: 1285985788
Provider Name (Legal Business Name): NORMA NICHOLE WALTON LCSW, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NORMA NICHOLE MCINTYRE

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402 APO AE
APO AE GERMANY
09180
DE

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402 APO AE
APO AE GERMANY
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 496371868590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007650
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007570
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079343
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: