Provider Demographics
NPI:1407493448
Name:WHEELER, BROOKE ALICIA
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALICIA
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 PAYSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:RINDGE
Mailing Address - State:NH
Mailing Address - Zip Code:03461-7818
Mailing Address - Country:US
Mailing Address - Phone:978-621-8261
Mailing Address - Fax:
Practice Address - Street 1:161 JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2103
Practice Address - Country:US
Practice Address - Phone:978-322-8665
Practice Address - Fax:978-221-6214
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor