Healthcare Provider Details

I. General information

NPI: 1609700269
Provider Name (Legal Business Name): WESLEY WILLIAMS LADAC, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

926 W OAKLAND AVE STE 202
JOHNSON CITY TN
37604-1445
US

IV. Provider business mailing address

926 W OAKLAND AVE STE 202
JOHNSON CITY TN
37604-1445
US

V. Phone/Fax

Practice location:
  • Phone: 423-850-1150
  • Fax: 865-888-5819
Mailing address:
  • Phone: 423-850-1150
  • Fax: 865-888-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1671
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16095
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: