Doctor Name: | GREGORY JOHN WIGHTMAN |
NPI Number: | 1073672275 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.P.C.C. SUPV. |
License Number: | E0000394 SUPV |
Business Practice Address: | 2611 Wayne Ave Building #66 Dayton, OH - 454201833 |
Business Phone Number: | 9372580440 |
Business Fax Number: | 9372586235 |
Mailing Address: | 30 E Broad St, 11th Floor COLUMBUS |
State: | OH |
Postal Code: | 432153414 |
Phone Number: | 6144666583 |
Fax Number: | 6149953268 |
NPI Enumeration Date: | 12/06/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | E0000394 SUPV |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |