Healthcare Provider Details

I. General information

NPI: 1851434559
Provider Name (Legal Business Name): JAMES WEEDEN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10811 SW 53RD CIR
OCALA FL
34476-7732
US

IV. Provider business mailing address

199 CHESTNUT ST
REHOBOTH MA
02769-2236
US

V. Phone/Fax

Practice location:
  • Phone: 508-880-6666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number561
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: