Provider Demographics
NPI:1770380693
Name:WIEDIS, DAVID (JD, MCCS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WIEDIS
Suffix:
Gender:M
Credentials:JD, MCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 S CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-2040
Mailing Address - Country:US
Mailing Address - Phone:610-517-0437
Mailing Address - Fax:
Practice Address - Street 1:1564 MCDANIEL DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-6672
Practice Address - Country:US
Practice Address - Phone:484-254-6559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral