Provider Demographics
NPI:1770715377
Name:AYDELOTTE-WODESKY, DENISE LYNN (LCPC, LADC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNN
Last Name:AYDELOTTE-WODESKY
Suffix:
Gender:F
Credentials:LCPC, LADC
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:LYNN
Other - Last Name:WODESKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC, LADC
Mailing Address - Street 1:4140 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1623
Mailing Address - Country:US
Mailing Address - Phone:702-254-4883
Mailing Address - Fax:702-259-4833
Practice Address - Street 1:4140 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1623
Practice Address - Country:US
Practice Address - Phone:702-254-4883
Practice Address - Fax:702-259-4833
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01192101YA0400X
NVCP0045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)