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NPI Code Detail

MEDICARE: CARL DESHON WEDDINGTON

MEDICARE: CARL DESHON WEDDINGTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1669984886
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARL DESHON WEDDINGTON
Provider Business Mailing Address
First Line : 415 COURT ST
Second Line :
City : PORT ALLEN
State : LA
Zip : 70767-2747
Country : US
Telephone Number : 225-245-9070
Fax Number : 225-245-9070
Provider Business Practice Location Address
First Line : 415 COURT ST
Second Line :
City : PORT ALLEN
State : LA
Zip : 70767-2747
Country : US
Telephone Number : 225-245-9070
Fax Number : 225-245-9073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2017
Last Update Date : 10/27/2017

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Directions to “ CARL DESHON WEDDINGTON ” Practice Location

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