Provider Demographics
NPI:1134000292
Name:WALDEN, DYASIA
Entity type:Individual
Prefix:
First Name:DYASIA
Middle Name:
Last Name:WALDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 GROVE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-3580
Mailing Address - Country:US
Mailing Address - Phone:229-421-9275
Mailing Address - Fax:
Practice Address - Street 1:1191 E NEWPORT CENTER DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7715
Practice Address - Country:US
Practice Address - Phone:954-644-0682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician