Provider Demographics
NPI:1295407765
Name:WEDDEL, JOSHUA (AAC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:WEDDEL
Suffix:
Gender:M
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COLUMBIA WELLNESS
Mailing Address - Street 2:PO BOX 1847
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-353-9369
Mailing Address - Fax:360-577-0187
Practice Address - Street 1:COLUMBIA WELLNESS
Practice Address - Street 2:720 14TH AVE
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-423-0203
Practice Address - Fax:360-423-5086
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61311960101YA0400X
WACG61220531101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)