Provider Demographics
NPI:1972270023
Name:WALDEN, PAULA CLEMMONS (LPC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:CLEMMONS
Last Name:WALDEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-4037
Mailing Address - Country:US
Mailing Address - Phone:706-728-0846
Mailing Address - Fax:
Practice Address - Street 1:909 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-4037
Practice Address - Country:US
Practice Address - Phone:706-728-0846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002934101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional