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General NPI Number Information
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NPI Number | 1750948832
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Entity Type | Individual
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Provider Name | CANDANCE YOLANDA WALTON MSW
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Gender | Female
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 351 KINGS FORK RD
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City | SUFFOLK
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State | VA
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Zip | 23434-7151
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Country | US
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Telephone | 757-923-5240
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Fax |
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Provider Business Mailing Address
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Address Line | 351 KINGS FORK RD
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City | SUFFOLK
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State | VA
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Zip | 23434-7151
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Country | US
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Telephone | 757-903-3014
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | PPS-0603725
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License Number State | VA
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