Provider Demographics
NPI:1164187373
Name:VEDOCK, AARON M (MSW)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:M
Last Name:VEDOCK
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 OLD HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8347
Mailing Address - Country:US
Mailing Address - Phone:304-365-4396
Mailing Address - Fax:
Practice Address - Street 1:708 OLD HICKORY DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8347
Practice Address - Country:US
Practice Address - Phone:304-365-4396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009427771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV908825Medicaid