Provider Demographics
NPI:1134681885
Name:KASANDRA WHEELER PLLC
Entity Type:Organization
Organization Name:KASANDRA WHEELER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:980-238-3454
Mailing Address - Street 1:10617 KETTERING DR STE 105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4900
Mailing Address - Country:US
Mailing Address - Phone:980-238-3454
Mailing Address - Fax:855-847-7645
Practice Address - Street 1:10617 KETTERING DR STE 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4900
Practice Address - Country:US
Practice Address - Phone:980-238-3454
Practice Address - Fax:855-847-7645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty