Provider Demographics
NPI:1053050575
Name:WHEATLE-PAUL, NOVLETT ANNIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NOVLETT
Middle Name:ANNIE
Last Name:WHEATLE-PAUL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:NOVLETT
Other - Middle Name:ANNIE
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4145 TURTLE MOUND RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8504
Mailing Address - Country:US
Mailing Address - Phone:321-427-3289
Mailing Address - Fax:
Practice Address - Street 1:1300 RED JOHN DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-1075
Practice Address - Country:US
Practice Address - Phone:386-254-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW79571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical