Provider Demographics
NPI:1457911620
Name:WALTON-SKINNER, TERESA (LPC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:WALTON-SKINNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7106 SMITHERS WAY SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-3886
Mailing Address - Country:US
Mailing Address - Phone:804-502-8483
Mailing Address - Fax:
Practice Address - Street 1:7106 SMITHERS WAY SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-3886
Practice Address - Country:US
Practice Address - Phone:804-502-8483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional