Provider Demographics
NPI:1760862957
Name:WALDER, D. DENISE (LICDC-CS)
Entity Type:Individual
Prefix:
First Name:D. DENISE
Middle Name:
Last Name:WALDER
Suffix:
Gender:F
Credentials:LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N JAMES H MCGEE BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-9526
Mailing Address - Country:US
Mailing Address - Phone:937-267-5089
Mailing Address - Fax:937-262-3523
Practice Address - Street 1:1800 N JAMES H MCGEE BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-9526
Practice Address - Country:US
Practice Address - Phone:937-267-5089
Practice Address - Fax:937-262-3523
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH981009101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)