=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134053481
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRENT WEDMAN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2026
-----------------------------------------------------
Last Update Date | 06/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 PHILADELPHIA PIKE
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19809-2042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-455-7661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 PHILADELPHIA PIKE
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19809-2042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-455-7661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | MR. BRENT ALEXANDER WEDMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-455-7661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------