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MR. MICHAEL CHARLES WEYAND MSW, LICSW, LCSW,

Addiction Substance Use Disorder

Vancouver, Washington

Provider NPI: 1871586222

Provider Information:
MR. MICHAEL CHARLES WEYAND MSW, LICSW, LCSW,
Gender: M
Not Sole Proprietor

Practice Location:
108 SE 124TH AVE  VANCOUVER, WA 98684 US
Tel: 360-891-7421  Fax: 360-253-8358

Business Mailing Address:
1601 E 4TH PLAIN BLVD  VANCOUVER, WA 98661 US
Tel: 360-624-2744  Fax: --

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
WACP00004960
N101YA0400XBehavioral Health & Social Service Providers
Counselor
OR03-R-04
N101YA0400XBehavioral Health & Social Service Providers
Counselor
MI2-00645
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
WALW00007884
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
ORL3386

Other Provider Identifiers:

IssuerNumberStateType
1871586222WA05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







ADDICTION JOBS WA - Page 1



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