Individual
MRS. LAURA MICHELLE WIEDLEBACHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, PCC-S, LICDC-CS
Contact information
Practice address
196 S MAIN ST STE 203, MARION, OH 43302-3967
(740) 375-9091
(740) 369-5931
Mailing address
196 S MAIN ST STE 203, MARION, OH 43302-3967
(740) 375-9091
(740) 369-5931
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
02/02/2007
Last updated
07/15/2019
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