Provider Demographics
NPI:1568896256
Name:WALDEN, DAVID PHILIP (EDD, LICENSED ADDI)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PHILIP
Last Name:WALDEN
Suffix:
Gender:M
Credentials:EDD, LICENSED ADDI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 OLD MINDEN RD
Mailing Address - Street 2:SUITE 1108
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112
Mailing Address - Country:US
Mailing Address - Phone:318-465-3849
Mailing Address - Fax:
Practice Address - Street 1:3018 OLD MINDEN RD
Practice Address - Street 2:SUITE 1108
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112
Practice Address - Country:US
Practice Address - Phone:318-465-3849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA418101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)