Provider Demographics
NPI:1174541411
Name:WHEELER, WANDA (MSW, LICSW, LCSW-C)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MSW, LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3710
Mailing Address - Country:US
Mailing Address - Phone:202-320-0544
Mailing Address - Fax:
Practice Address - Street 1:4501 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 111
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-3710
Practice Address - Country:US
Practice Address - Phone:202-320-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3035781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical