Individual
MR. JONATHAN WIESNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAC II
Contact information
Practice address
250 SCENIC HWY, LAWRENCEVILLE, GA 30046-5675
(678) 442-5800
Mailing address
250 SCENIC HWY S, LAWRENCEVILLE, GA 30046-5675
(678) 442-5800
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1971
GA
Other
Enumeration date
06/30/2014
Last updated
06/30/2014
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