Provider Demographics
NPI:1043923915
Name:WHEELER, JESSICA A (ADS, CRSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:A
Last Name:WHEELER
Suffix:
Gender:F
Credentials:ADS, CRSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WEBSTER ST # 2
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2504
Mailing Address - Country:US
Mailing Address - Phone:603-851-4756
Mailing Address - Fax:
Practice Address - Street 1:20 MARKET ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1957
Practice Address - Country:US
Practice Address - Phone:603-487-6727
Practice Address - Fax:603-622-7328
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0190101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)