Basic Information
| Provider Information | |||||||||
| NPI: | 1679697510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALTON | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | KIM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1259 SOUTH BERETANIA STREET | ||||||||
| Address2: | UNIT 4 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085911173 | ||||||||
| FaxNumber: | 8085911174 | ||||||||
| Practice Location | |||||||||
| Address1: | 1259 SOUTH BERETANIA STREET | ||||||||
| Address2: | UNIT 4 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085911173 | ||||||||
| FaxNumber: | 8085911174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2007 | ||||||||
| LastUpdateDate: | 09/03/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | 1-00-0056 | HI | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103T00000X | PSY1099 | HI | Y | Behavioral Health & Social Service Providers | Psychologist | 103K00000X | 1-00-0056 | N | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.