Healthcare Provider Details

I. General information

NPI: 1174585137
Provider Name (Legal Business Name): ANITA G WIEST L.C.S.W.; L.C.A.D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAKE ST
SALISBURY MD
21801-3141
US

IV. Provider business mailing address

540 RIVERSIDE DR STE 8
SALISBURY MD
21801-5352
US

V. Phone/Fax

Practice location:
  • Phone: 410-742-3460
  • Fax:
Mailing address:
  • Phone: 410-632-1100
  • Fax: 410-632-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11318
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA331
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: