Provider Demographics
NPI:1831209758
Name:WENCE, DAVID RAY (D MIN LCPC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAY
Last Name:WENCE
Suffix:
Gender:M
Credentials:D MIN LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 N UNIVERSITY AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1351
Mailing Address - Country:US
Mailing Address - Phone:217-872-1700
Mailing Address - Fax:217-872-1366
Practice Address - Street 1:3040 N UNIVERSITY AVE
Practice Address - Street 2:STE 2
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1351
Practice Address - Country:US
Practice Address - Phone:217-872-1700
Practice Address - Fax:217-872-1366
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0035840188OtherBLUE CROSS BLUE SHIELD