Healthcare Provider Details

I. General information

NPI: 1700641289
Provider Name (Legal Business Name): SECARRA DAVIDA WALTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19702 NARVI CT
SPRING TX
77379-1475
US

IV. Provider business mailing address

4823 FOREST HURST GLN
SPRING TX
77373-2401
US

V. Phone/Fax

Practice location:
  • Phone: 832-409-4417
  • Fax: 833-320-8545
Mailing address:
  • Phone: 951-662-3543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number88834
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: