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General NPI Number Information
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NPI Number | 1275353195
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Entity Type | Individual
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Provider Name | MARCUS W WALTON LCMHCA
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Gender | Male
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 307 W GEER ST APT A
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City | DURHAM
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State | NC
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Zip | 27701-2237
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Country | US
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Telephone | 919-885-4079
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 NORTH DUKE ST STE 1 #1076
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City | DURHAM
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State | NC
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Zip | 27704
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Country | US
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Telephone | 919-885-4079
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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