Provider Demographics
NPI:1770058752
Name:WEDDINGTON, TIMOTHY MATTHEW (LPCC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MATTHEW
Last Name:WEDDINGTON
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:MR
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:WEDDINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:805 CARNEAL RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-3601
Mailing Address - Country:US
Mailing Address - Phone:859-230-0784
Mailing Address - Fax:
Practice Address - Street 1:805 CARNEAL RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-3601
Practice Address - Country:US
Practice Address - Phone:859-230-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242880101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional