Provider Demographics
NPI:1114268729
Name:WIESZCZYK, PHILIP GREGORY (LPC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:GREGORY
Last Name:WIESZCZYK
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 1:1504 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2510
Mailing Address - Country:US
Mailing Address - Phone:814-873-1859
Mailing Address - Fax:
Practice Address - Street 1:1504 N 22ND ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2510
Practice Address - Country:US
Practice Address - Phone:484-353-6193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011537101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional