Individual
LAWRENCE WIELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISAC
Contact information
Practice address
2950 S ALMA SCHOOL RD, #11, MESA, AZ 85210-4035
(480) 430-0169
Mailing address
2950 S ALMA SCHOOL RD, #11, MESA, AZ 85210-4035
(480) 430-0169
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC0673
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173036
—
AZ
Enumeration date
05/03/2007
Last updated
07/08/2007
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