Provider Demographics
NPI:1114286655
Name:WIELT, DUSTIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:WIELT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 SAINT PHILIP ST
Mailing Address - Street 2:APT #A
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-2408
Mailing Address - Country:US
Mailing Address - Phone:504-452-8438
Mailing Address - Fax:
Practice Address - Street 1:1601 PERDIDO ST
Practice Address - Street 2:SOUTHEAST LOUISIANA VETERAN HEALTHCARE SYSTEM
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1262
Practice Address - Country:US
Practice Address - Phone:504-988-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1172103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical