Healthcare Provider Details

I. General information

NPI: 1649202300
Provider Name (Legal Business Name): WILLIE GEORGE WEDDINGTON ED. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BILL G. WEDDINGTON ED. D.

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 KAREN DR
NAPA CA
94558-4120
US

IV. Provider business mailing address

108 KAREN DR
NAPA CA
94558-4120
US

V. Phone/Fax

Practice location:
  • Phone: 707-224-5332
  • Fax:
Mailing address:
  • Phone: 707-224-5332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY9967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: