Provider Demographics
NPI:1306981204
Name:WALDING, AUREAU C (LCSW)
Entity type:Individual
Prefix:MISS
First Name:AUREAU
Middle Name:C
Last Name:WALDING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AUREAU
Other - Middle Name:
Other - Last Name:WALDING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10275 OLD SAINT AUGUSTINE RD APT 216
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-7672
Mailing Address - Country:US
Mailing Address - Phone:816-977-9079
Mailing Address - Fax:
Practice Address - Street 1:10275 OLD SAINT AUGUSTINE RD APT 216
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-7672
Practice Address - Country:US
Practice Address - Phone:816-977-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070002241041C0700X
FLSW102391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH47F172Medicare UPIN