Provider Demographics
NPI:1710400619
Name:WEINER, ROXANNE MARIE (LMHC-A)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:MARIE
Last Name:WEINER
Suffix:
Gender:F
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2429
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8486
Mailing Address - Country:US
Mailing Address - Phone:360-397-8228
Mailing Address - Fax:360-397-8251
Practice Address - Street 1:7700 NE 26TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0672
Practice Address - Country:US
Practice Address - Phone:360-397-8228
Practice Address - Fax:360-397-8251
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61226072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health