| Doctor Name: | SEVERIN SUSAN WALSTON |
| NPI Number: | 1104293935 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 370 9th St Crescent City, CA - 955313432 |
| Business Phone Number: | 7074644349 |
| Business Fax Number: | 7074654572 |
| Mailing Address: | 370 9th St, CRESCENT CITY |
| State: | CA |
| Postal Code: | 955313432 |
| Phone Number: | 7074644349 |
| Fax Number: | 7074654572 |
| NPI Enumeration Date: | 08/27/2015 |
| NPI Last Update Date: | 08/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |