Healthcare Provider Details

I. General information

NPI: 1760494785
Provider Name (Legal Business Name): WANDA W WALTON LPC, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 RICHMOND STREET
SELMA VA
24474
US

IV. Provider business mailing address

PO BOX 427
CLIFTON FORGE VA
24422-0427
US

V. Phone/Fax

Practice location:
  • Phone: 540-862-2489
  • Fax: 540-862-3176
Mailing address:
  • Phone: 540-862-2489
  • Fax: 540-862-3176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710000347
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701001809
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: