Provider Demographics
NPI:1518577170
Name:CONNIE WESLEY LCMFT LLC
Entity Type:Organization
Organization Name:CONNIE WESLEY LCMFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCMFT
Authorized Official - Phone:443-418-6646
Mailing Address - Street 1:1562 DOCKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4473
Mailing Address - Country:US
Mailing Address - Phone:443-418-6646
Mailing Address - Fax:
Practice Address - Street 1:111 HOLLING DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5051
Practice Address - Country:US
Practice Address - Phone:443-418-6646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health