Provider Demographics
NPI:1609412519
Name:WEDGEWORTH, LISA FAYE (LPC-ASSOCIATE, LCDC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:FAYE
Last Name:WEDGEWORTH
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE, LCDC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:WALDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 CASIE CT
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-7613
Mailing Address - Country:US
Mailing Address - Phone:940-799-1768
Mailing Address - Fax:
Practice Address - Street 1:325 CASIE CT
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-7613
Practice Address - Country:US
Practice Address - Phone:940-799-1768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)