MEDICARE: ABBEY MARIE WIERDA MA, LPC, LLMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1922589381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBEY MARIE WIERDA MA, LPC, LLMFT

Provider Business Mailing Address
First Line	:	1856 SPENCER DR
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-4536
Country	:	US
Telephone Number	:	231-286-6066
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S BEACON BLVD # A2
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2178
Country	:	US
Telephone Number	:	231-286-6066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	10/25/2022

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