Provider Demographics
NPI:1073693990
Name:GEORGE LARRY WHEELER SR
Entity Type:Organization
Organization Name:GEORGE LARRY WHEELER SR
Other - Org Name:CIRCLE OF HOPE PSYCHOTHERAPY & ADDICTIONS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:SR
Authorized Official - Credentials:PSYD,MBA,CEAP,SAP,L,
Authorized Official - Phone:202-265-2343
Mailing Address - Street 1:3000 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 321
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2509
Mailing Address - Country:US
Mailing Address - Phone:202-265-2343
Mailing Address - Fax:202-248-9076
Practice Address - Street 1:3000 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 321
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2509
Practice Address - Country:US
Practice Address - Phone:202-265-2343
Practice Address - Fax:202-248-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003368101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073693990Medicaid
VA004949978Medicaid