Provider Demographics
NPI:1639476138
Name:MEINER, WILMA JOY (LASAC)
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:JOY
Last Name:MEINER
Suffix:
Gender:F
Credentials:LASAC
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:MEINER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:554 S BELLVIEW
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-2504
Mailing Address - Country:US
Mailing Address - Phone:480-461-1711
Mailing Address - Fax:480-833-5772
Practice Address - Street 1:554 S BELLVIEW
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-2504
Practice Address - Country:US
Practice Address - Phone:480-461-1711
Practice Address - Fax:480-833-5772
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLASAC-13204101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)