Healthcare Provider Details

I. General information

NPI: 1821911959
Provider Name (Legal Business Name): HENRY DAVID WALDEN BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 5TH AVE SE
MOULTRIE GA
31768-4728
US

IV. Provider business mailing address

PO BOX 2375
MOULTRIE GA
31776-2375
US

V. Phone/Fax

Practice location:
  • Phone: 229-616-9707
  • Fax: 229-890-1305
Mailing address:
  • Phone: 229-616-9707
  • Fax: 229-890-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: