Provider Demographics
NPI:1053760751
Name:WALSTON, CARRIE (L AC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:WALSTON
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LAMBDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3158
Mailing Address - Country:US
Mailing Address - Phone:301-467-6605
Mailing Address - Fax:
Practice Address - Street 1:611 S BRADDOCK ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4050
Practice Address - Country:US
Practice Address - Phone:301-467-6605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121-000820171100000X
MDU02236171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist