Individual
MRS. KELLY ALICIA WIENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LCMHC
Contact information
Practice address
467 LAUREL BRANCH RD, VILAS, NC 28692-9152
(919) 815-1382
Mailing address
467 LAUREL BRANCH RD, VILAS, NC 28692-9152
(919) 815-1382
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
3873
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6102318
—
NC
Enumeration date
10/03/2006
Last updated
04/18/2023
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