Provider Demographics
NPI:1033641824
Name:WISE, JOHN (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WISE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9064 HELENA RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2737
Mailing Address - Country:US
Mailing Address - Phone:205-644-1166
Mailing Address - Fax:800-514-9302
Practice Address - Street 1:9064 HELENA RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-2737
Practice Address - Country:US
Practice Address - Phone:205-644-1166
Practice Address - Fax:800-514-9302
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional