Individual
DAVID WIEBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
510 TACOMA AVE S, TACOMA, WA 98402-5416
(253) 502-5424
Mailing address
510 TACOMA AVE S, TACOMA, WA 98402-5416
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60732476
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60732476
CDPT
WA
Enumeration date
02/16/2018
Last updated
02/16/2018
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