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General NPI Number Information
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NPI Number | 1740068048
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Entity Type | Organization
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Legal Business Name | SHELLY WIEWIORA LLC
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 433 SEMINOLE RD STE 101
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City | NORTON SHORES
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State | MI
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Zip | 49444-3743
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Country | US
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Telephone | 231-286-6077
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Fax |
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Provider Business Mailing Address
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Address Line | 433 SEMINOLE RD STE 101
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City | NORTON SHORES
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State | MI
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Zip | 49444-3743
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Country | US
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Telephone | 231-286-6077
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | SHELLY WIEWIORA
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Credential | LPC
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Telephone | 231-286-6077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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