Provider Demographics
NPI:1801505524
Name:WALDEN, SAMUEL EDDIE (LPC, CAADC)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:EDDIE
Last Name:WALDEN
Suffix:
Gender:
Credentials:LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 BLOOMINGDALE ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-4936
Mailing Address - Country:US
Mailing Address - Phone:706-836-7715
Mailing Address - Fax:
Practice Address - Street 1:234 CENTRAL HOSPITAL RD BLDG 329
Practice Address - Street 2:
Practice Address - City:FORT EISENHOWER
Practice Address - State:GA
Practice Address - Zip Code:30905-6003
Practice Address - Country:US
Practice Address - Phone:706-787-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014158101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional