Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | ||
Y | 103TC1900X | Counseling Psychologist |
NPI | 1083966287 |
---|---|
Provider Name | Gregory Andrew Weichhand JR. |
First Address | Grand Rapids, MI 49504-6046 |
Second Address | Grand Rapids, MI 49525-9334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2012 |
Last Update Date | 12/05/2016 |