Individual
MRS. KELLY LOUISE WIEBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
2224 BIG LAKE CT, RALEIGH, NC 27607-6326
(573) 449-4323
Mailing address
2224 BIG LAKE CT, RALEIGH, NC 27607-6326
(573) 449-4323
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
2003025232
MO
106H00000X
Marriage & Family Therapist
Primary
1288
NC
106H00000X
Marriage & Family Therapist
2002017783
MO
Other
Enumeration date
04/23/2007
Last updated
11/28/2018
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