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: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 E PARK AVE
NILES OH
44446-2352
US

IV. Provider business mailing address

178 E UNDER RIDGE RD
CONNEAUT OH
44030-9661
US

V. Phone/Fax

Practice location:
  • Phone: 330-544-8005
  • Fax:
Mailing address:
  • Phone: 814-573-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2606797
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: