Provider Demographics
NPI:1649535246
Name:WALDEN, JEREMY T (PSYD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:T
Last Name:WALDEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 BROWNS HILL CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-9511
Mailing Address - Country:US
Mailing Address - Phone:804-893-5555
Mailing Address - Fax:804-893-5553
Practice Address - Street 1:312 BROWNS HILL CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-9511
Practice Address - Country:US
Practice Address - Phone:804-893-5555
Practice Address - Fax:804-893-5553
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling