Individual
GORDON D. WIELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPCC
Contact information
Practice address
3102 PLOVER RD, LOUISVILLE, KY 40213-1229
(502) 403-6054
Mailing address
3102 PLOVER RD, LOUISVILLE, KY 40213-1229
(502) 403-6054
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
166
OK
101YP2500X
Professional Counselor
Primary
102155
KY
101YP2500X
Professional Counselor
3491
OK
Other
Enumeration date
03/06/2007
Last updated
01/08/2019
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