| Doctor Name: | MRS. JEDIDAH WANGONDU |
| NPI Number: | 1093179053 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 3418 |
| Business Practice Address: | 1605 Main St Daphne, AL - 365264463 |
| Business Phone Number: | 2516215360 |
| Business Fax Number: | 2516215361 |
| Mailing Address: | 1605 Main St, DAPHNE |
| State: | AL |
| Postal Code: | 365264463 |
| Phone Number: | 2516215360 |
| Fax Number: | 2516215361 |
| NPI Enumeration Date: | 04/06/2016 |
| NPI Last Update Date: | 04/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 3418 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |