Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YP1600X | Pastoral Counselor |
NPI | 1174117717 |
---|---|
Provider Name | Gloria Jean Weber |
First Address | Fremont, OH 43420-1637 |
Second Address | Fremont, OH 43420-2441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2021 |
Last Update Date | 24/02/2021 |