Provider Demographics
NPI:1285898130
Name:WELDON, CLIFTON J SR (MA)
Entity type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:J
Last Name:WELDON
Suffix:SR
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:CLIFF
Other - Middle Name:
Other - Last Name:WELDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:145 DAVENPORT RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-4587
Mailing Address - Country:US
Mailing Address - Phone:215-668-8855
Mailing Address - Fax:
Practice Address - Street 1:145 DAVENPORT RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-4587
Practice Address - Country:US
Practice Address - Phone:267-225-1730
Practice Address - Fax:302-653-2689
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC006391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)