Doctor Name: | DR. JANICE WALTON |
NPI Number: | 1134235641 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | PY0005827 |
Business Practice Address: | 100 Executive Way Ste 110 Ponte Vedra Beach, FL - 320824753 |
Business Phone Number: | 9048342235 |
Business Fax Number: | 8665318858 |
Mailing Address: | 100 Executive Way, Ste 110 PONTE VEDRA BEACH |
State: | FL |
Postal Code: | 320824753 |
Phone Number: | 9048342235 |
Fax Number: | 8665318858 |
NPI Enumeration Date: | 08/21/2006 |
NPI Last Update Date: | 02/05/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PY0005827 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |