Provider Demographics
NPI:1053654889
Name:LUCKENBILL-WHEELER, AMY R (MSW, LSW, LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:LUCKENBILL-WHEELER
Suffix:
Gender:F
Credentials:MSW, LSW, LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:R
Other - Last Name:LUCKENBILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW, LCSW
Mailing Address - Street 1:4461 OLD PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7903
Mailing Address - Country:US
Mailing Address - Phone:610-451-5255
Mailing Address - Fax:
Practice Address - Street 1:4461 OLD PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7903
Practice Address - Country:US
Practice Address - Phone:610-451-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040081301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical