Provider Demographics
NPI:1265631857
Name:WHEELER, WADE (LCSW)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:WHEELER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13570 SW 173RD CT
Mailing Address - Street 2:
Mailing Address - City:ARCHER
Mailing Address - State:FL
Mailing Address - Zip Code:32618-5351
Mailing Address - Country:US
Mailing Address - Phone:352-949-4665
Mailing Address - Fax:
Practice Address - Street 1:13570 SW 173RD CT
Practice Address - Street 2:
Practice Address - City:ARCHER
Practice Address - State:FL
Practice Address - Zip Code:32618-5351
Practice Address - Country:US
Practice Address - Phone:352-949-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.000011161041C0700X
TNCSW00000070451041C0700X
COCSW 0001161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW 0000116OtherDORA