Healthcare Provider Details

I. General information

NPI: 1184295073
Provider Name (Legal Business Name): TOKA DAMONE WALTERS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 E UNDER RIDGE RD
CONNEAUT OH
44030-9661
US

IV. Provider business mailing address

178 E UNDER RIDGE RD
CONNEAUT OH
44030-9661
US

V. Phone/Fax

Practice location:
  • Phone: 814-573-4113
  • Fax:
Mailing address:
  • Phone: 814-573-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2103202
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: