| Walston Health Services Llc | |
|
6164 Fuller Ct Alexandria VA 22310-2540 | |
| (703) 924-9810 | |
| (703) 924-7044 |
| Full Name | Walston Health Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6164 Fuller Ct, Alexandria, Virginia |
| Authorized Official Name and Position | Tonya L Walston (OWNER) |
| Authorized Official Contact | 7039249810 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Walston Health Services Llc 6164 Fuller Ct Alexandria VA 22310-2540 Ph: (703) 924-9810 | Walston Health Services Llc 6164 Fuller Ct Alexandria VA 22310-2540 Ph: (703) 924-9810 |
| NPI Number | 1023460912 |
|---|---|
| Provider Enumeration Date | 07/05/2016 |
| Last Update Date | 08/28/2024 |
| Certification Date | 08/28/2024 |
| Medicare PECOS PAC ID | 0244592798 |
|---|---|
| Medicare Enrollment ID | O20180320002959 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023460912 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 0024173415 (Virginia) | Primary |
| Provider Name | Kimmala S Roundtree |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205210788 PECOS PAC ID: 0547576589 Enrollment ID: I20150904001562 |
| Provider Name | Tonya Walston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265894745 PECOS PAC ID: 7214211051 Enrollment ID: I20170223000340 |
| Provider Name | Nora M Vassar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548504467 PECOS PAC ID: 0840443859 Enrollment ID: I20200819003805 |
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