Provider Demographics
NPI:1003053232
Name:WHEELER, CANDACE L (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:L
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 LUMPKIN CAMPGROUND RD S
Mailing Address - Street 2:SUITE 240
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-0922
Mailing Address - Country:US
Mailing Address - Phone:706-531-4929
Mailing Address - Fax:
Practice Address - Street 1:671 LUMPKIN CAMPGROUND RD S
Practice Address - Street 2:SUITE 240
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-0922
Practice Address - Country:US
Practice Address - Phone:706-531-4929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002267101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002267OtherLICENSED PROFESSIONAL COUNSELOR