Provider Demographics
NPI:1467633347
Name:WEDDLE, KAREN MICHELLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MICHELLE
Last Name:WEDDLE
Suffix:
Gender:F
Credentials:LPC
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 102
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-0102
Mailing Address - Country:US
Mailing Address - Phone:434-572-8000
Mailing Address - Fax:434-572-8030
Practice Address - Street 1:554 N MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3206
Practice Address - Country:US
Practice Address - Phone:434-572-8000
Practice Address - Fax:434-572-8030
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional