Doctor Name: | PAUL DUDLEY WEAVER |
NPI Number: | 1528469137 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | LPC007080 |
Business Practice Address: | 631 Willow Creek Rd Leicester, NC - 287485646 |
Business Phone Number: | 8283180148 |
Business Fax Number: | 8286834345 |
Mailing Address: | 631 Willow Creek Rd, LEICESTER |
State: | NC |
Postal Code: | 287485646 |
Phone Number: | 8283180148 |
Fax Number: | 8286834345 |
NPI Enumeration Date: | 09/15/2014 |
NPI Last Update Date: | 08/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC007080 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |