Provider Demographics
NPI:1780895177
Name:WEINHOLD, PAUL FREDRIC (DMIN LCPC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FREDRIC
Last Name:WEINHOLD
Suffix:
Gender:M
Credentials:DMIN LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 BAKERSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-0640
Mailing Address - Country:US
Mailing Address - Phone:618-867-2768
Mailing Address - Fax:
Practice Address - Street 1:604 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3309
Practice Address - Country:US
Practice Address - Phone:618-457-6703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional