Provider Demographics
NPI:1073038949
Name:VEDRINE, WENDY (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:VEDRINE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DIX AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-4851
Mailing Address - Country:US
Mailing Address - Phone:404-903-5840
Mailing Address - Fax:
Practice Address - Street 1:126 PROSPECT ST STE 206
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4476
Practice Address - Country:US
Practice Address - Phone:401-400-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health