Individual
LORI GAYLE WENGLIKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
412 CENTURY LN, HOLLAND, MI 49423-4285
(616) 396-2301
(616) 396-8070
Mailing address
412 CENTURY LN, HOLLAND, MI 49423-4285
(616) 396-2301
(616) 396-8070
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1-04700
MI
101YM0800X
Mental Health Counselor
Primary
6801097918
MI
Other
Enumeration date
03/20/2013
Last updated
03/17/2018
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