Provider Demographics
NPI:1679697510
Name:WALTON, CHRISTINE KIM (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:KIM
Last Name:WALTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 SOUTH BERETANIA STREET
Mailing Address - Street 2:UNIT 4
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-591-1173
Mailing Address - Fax:808-591-1174
Practice Address - Street 1:1259 SOUTH BERETANIA STREET
Practice Address - Street 2:UNIT 4
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-591-1173
Practice Address - Fax:808-591-1174
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-00-0056103TB0200X
HIPSY1099103T00000X
1-00-0056103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst