Provider Demographics
NPI:1740483346
Name:WEYANDT, JEANETTE DAWN (MAED, NCC, LPC)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:DAWN
Last Name:WEYANDT
Suffix:
Gender:F
Credentials:MAED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 WILLOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1421
Mailing Address - Country:US
Mailing Address - Phone:336-760-2996
Mailing Address - Fax:
Practice Address - Street 1:645 WILLOWBROOK LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-1421
Practice Address - Country:US
Practice Address - Phone:336-760-2996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional