Provider Demographics
NPI:1568155661
Name:WIET, JUSTIN JAMES
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JAMES
Last Name:WIET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-4813
Mailing Address - Country:US
Mailing Address - Phone:828-457-9198
Mailing Address - Fax:
Practice Address - Street 1:128 CHARLES ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-4813
Practice Address - Country:US
Practice Address - Phone:828-457-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker