Provider Demographics
NPI:1649202300
Name:WEDDINGTON, WILLIE G (ED D PSYCHOLOGY)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:G
Last Name:WEDDINGTON
Suffix:
Gender:M
Credentials:ED D PSYCHOLOGY
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:G
Other - Last Name:WEDDINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ED D PSYCHOLOGY
Mailing Address - Street 1:532 OREGON STREET
Mailing Address - Street 2:SUITE 10
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590
Mailing Address - Country:US
Mailing Address - Phone:707-224-5332
Mailing Address - Fax:707-224-5332
Practice Address - Street 1:532 OREGON ST
Practice Address - Street 2:SUITE 10
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3254
Practice Address - Country:US
Practice Address - Phone:707-224-5332
Practice Address - Fax:707-224-5332
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9967103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical