Individual
MARY E WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA, SWA
Contact information
Practice address
111 S BROAD ST STE 209, LANCASTER, OH 43130-4383
(440) 260-8300
(440) 260-8575
Mailing address
434 EASTLAND RD, BEREA, OH 44017-1217
(440) 260-8300
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
188413
OH
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
03/29/2023
Last updated
08/28/2024
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