Healthcare Provider Details

I. General information

NPI: 1770380693
Provider Name (Legal Business Name): DAVID WIEDIS J.D., M.C.C.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1564 MCDANIEL DR
WEST CHESTER PA
19380-6672
US

IV. Provider business mailing address

485 S CREEK RD
WEST CHESTER PA
19382-2040
US

V. Phone/Fax

Practice location:
  • Phone: 484-254-6559
  • Fax:
Mailing address:
  • Phone: 610-517-0437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: