Provider Demographics
NPI:1043223142
Name:WHEELER, ROBERT ALAN (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
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 1:100 GOLD ST NE
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4020
Mailing Address - Country:US
Mailing Address - Phone:252-265-8434
Mailing Address - Fax:252-206-4069
Practice Address - Street 1:100 GOLD ST NE
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4020
Practice Address - Country:US
Practice Address - Phone:252-265-8434
Practice Address - Fax:252-206-4069
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO48641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200179438OtherTAX ID #
NC6003174Medicaid
NC2867966BMedicare PIN