Healthcare Provider Details

I. General information

NPI: 1194215103
Provider Name (Legal Business Name): DAYMOND CORTES WALTON LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 NE ST JOHNS RD
VANCOUVER WA
98661-2573
US

IV. Provider business mailing address

9208 NE HIGHWAY 99 # 107-44
VANCOUVER WA
98665
US

V. Phone/Fax

Practice location:
  • Phone: 360-695-1325
  • Fax:
Mailing address:
  • Phone: 502-558-5307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number241557
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: