Provider Demographics
NPI:1609943133
Name:WENDORF, DONALD JOSEPH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOSEPH
Last Name:WENDORF
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 GILLON DR
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6507
Mailing Address - Country:US
Mailing Address - Phone:205-945-1129
Mailing Address - Fax:
Practice Address - Street 1:2700 ROGERS DR STE 101
Practice Address - Street 2:PITTS & ASSOCIATES, INCORPORATED
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-2055
Practice Address - Country:US
Practice Address - Phone:205-870-3520
Practice Address - Fax:205-870-3522
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL255103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51070830OtherTRICARE
AL00563083211501OtherCIGNA
AL3390Medicaid
AL00051506336WENOtherBCBS
AL61-90258OtherUNITED BEHAVIORAL HEALTH
ALR76055Medicare UPIN
ALR76055Medicare ID - Type Unspecified