=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558890095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEGGTALK, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2017
-----------------------------------------------------
Last Update Date | 06/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3031 HAWTHORNE DR NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20017-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-299-0096
-----------------------------------------------------
Fax | 202-299-0096
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3031 HAWTHORNE DR NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20017-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 12022990096
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/CEO
-----------------------------------------------------
Name | DR. DONNA RENA WALTON
-----------------------------------------------------
Credential | EDD, CCBT
-----------------------------------------------------
Telephone | 202-299-0096
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------