Provider Demographics
NPI:1386349272
Name:WALTON, CHRISTOPHER DWAYNE
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DWAYNE
Last Name:WALTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7531 OLD PUMP RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3917
Mailing Address - Country:US
Mailing Address - Phone:334-354-5323
Mailing Address - Fax:
Practice Address - Street 1:2361 FAIRLANE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1633
Practice Address - Country:US
Practice Address - Phone:334-790-7460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2023-029103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst