Healthcare Provider Details

I. General information

NPI: 1770058984
Provider Name (Legal Business Name): LISA MARIE WIEHE LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 E DUBLIN GRANVILLE RD
COLUMBUS OH
43229-8187
US

IV. Provider business mailing address

665 E DUBLIN GRANVILLE RD
COLUMBUS OH
43229-8187
US

V. Phone/Fax

Practice location:
  • Phone: 614-846-6265
  • Fax:
Mailing address:
  • Phone: 614-846-6265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0003166-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0003166
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: