Provider Information for 1194215103
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DAYMOND CORTES WALTON LPCC
Sex: Male
NPI: 1194215103
Last Updated: 2024-06-07
Certification Date: 2024-06-07
Certification Date: 2024-06-07
Details
| Name | Value | ||||||||
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| NPI | 1194215103 | ||||||||
| Enumeration Date | 2018-05-15 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 9208 NE HIGHWAY 99 # 107-44 VANCOUVER, WA 98665 United States Phone: 502-558-5307 | Fax: | ||||||||
| Primary Practice Address | 2210 GOLDSMITH LN STE 222 LOUISVILLE, KY 40218-1070 United States Phone: 502-245-1576 | Fax: | ||||||||
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