Provider Demographics
NPI:1023367562
Name:WHEELER, CLINT A (LCSW)
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:A
Last Name:WHEELER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-2212
Mailing Address - Country:US
Mailing Address - Phone:423-573-6836
Mailing Address - Fax:423-573-6836
Practice Address - Street 1:10434 JACKSON OAKS WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3293
Practice Address - Country:US
Practice Address - Phone:865-730-4171
Practice Address - Fax:423-388-4774
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN64731041C0700X, 1041C0700X
TN9754104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker