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General NPI Number Information
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NPI Number | 1497255426
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Entity Type | Individual
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Provider Name | DUSTIN WEIDMAN LLC
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Gender | Male
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 323 N STATE ST
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City | CARO
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State | MI
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Zip | 48723-1537
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Country | US
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Telephone | 989-673-6191
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Fax |
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Provider Business Mailing Address
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Address Line | 323 N STATE ST
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City | CARO
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State | MI
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Zip | 48723-1537
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6451023405
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License Number State | MI
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