Provider Demographics
NPI:1114439536
Name:WISE, MARGARET (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:
Last Name:WISE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 CARTER RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3811
Mailing Address - Country:US
Mailing Address - Phone:757-589-1046
Mailing Address - Fax:
Practice Address - Street 1:2006 OLD GREENBRIER RD STE 5
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2648
Practice Address - Country:US
Practice Address - Phone:757-961-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040101271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty