Provider Demographics
NPI:1710346796
Name:WIMMER, MARIBETH (MACC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARIBETH
Middle Name:
Last Name:WIMMER
Suffix:
Gender:F
Credentials:MACC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16607 RIVERSTONE WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-5749
Mailing Address - Country:US
Mailing Address - Phone:980-250-2438
Mailing Address - Fax:
Practice Address - Street 1:16607 RIVERSTONE WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5749
Practice Address - Country:US
Practice Address - Phone:980-250-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7467101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional