Provider Demographics
NPI:1356498117
Name:WEEKS, CHRISTIAN DEWOLF (LMHC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:DEWOLF
Last Name:WEEKS
Suffix:
Gender:M
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:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:EAST DORSET
Mailing Address - State:VT
Mailing Address - Zip Code:05253-0025
Mailing Address - Country:US
Mailing Address - Phone:401-617-2737
Mailing Address - Fax:
Practice Address - Street 1:231 BONNET ST # 4
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-7300
Practice Address - Country:US
Practice Address - Phone:401-617-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30343OtherBLUE CROSS OF RHODE ISLAND