Doctor Name: | PAMELA L WIZNER |
NPI Number: | 1043469646 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 6401006060 |
Business Practice Address: | 1650 Barlow St #3 Traverse City, MI - 496864721 |
Business Phone Number: | 5866681366 |
Business Fax Number: | 2318393322 |
Mailing Address: | 8630 W Peterson Point Rd, LAKE CITY |
State: | MI |
Postal Code: | 496519051 |
Phone Number: | 5866681366 |
Fax Number: | 2318393322 |
NPI Enumeration Date: | 09/18/2008 |
NPI Last Update Date: | 09/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 6401006060 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |