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Individual
MR. EVAN CRAIG WISNER
Active
Individual
MR. EVAN CRAIG WISNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLMSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
6801104507
MI
1041C0700X
Clinical Social Worker
Primary
6801104507
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801104507
MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS - BOARD OF SOCIAL WORK
MI
Enumeration date
11/24/2019
Last updated
03/11/2021
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