| NPI | 1568772515 |
|---|---|
| Former Name | STACEY RENEE WALTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 19410) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker | |
| Enumeration Date | 2010-10-08 |
| Last Update Date | 2022-05-11 |