Individual
LARRY LIEDKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
125 W MAIN ST, SUIT B, WAUCHULA, FL 33873-2819
(863) 448-4332
Mailing address
125 W MAIN ST, SUIT B, WAUCHULA, FL 33873-2819
(863) 448-4332
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/21/2014
Last updated
10/21/2014
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