Provider Demographics
NPI:1821629239
Name:WUEBBLING, KRISTOPHER C (LPC, ATR-BC, CAADC)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:C
Last Name:WUEBBLING
Suffix:
Gender:M
Credentials:LPC, ATR-BC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 MARKET ST STE A307
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-7501
Mailing Address - Country:US
Mailing Address - Phone:267-209-0010
Mailing Address - Fax:267-930-6250
Practice Address - Street 1:1735 MARKET ST STE A307
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-7501
Practice Address - Country:US
Practice Address - Phone:267-209-0010
Practice Address - Fax:267-930-6250
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA12442101YA0400X
18-018221700000X
PAPC011367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist