Provider Demographics
NPI:1598470007
Name:WIERINGA, JOSHUA (LMSW)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:WIERINGA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8643 CRANE RD
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-9795
Mailing Address - Country:US
Mailing Address - Phone:734-431-8008
Mailing Address - Fax:
Practice Address - Street 1:1235 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1741
Practice Address - Country:US
Practice Address - Phone:734-786-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68011145701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical