Provider Demographics
NPI:1417114950
Name:WHEELER, GEORGE LARRY SR (PSYD, LPC,CEAP,SAP)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LARRY
Last Name:WHEELER
Suffix:SR
Gender:M
Credentials:PSYD, LPC,CEAP,SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE #321
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2509
Mailing Address - Country:US
Mailing Address - Phone:202-265-2343
Mailing Address - Fax:202-248-9076
Practice Address - Street 1:3000 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE #321
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2509
Practice Address - Country:US
Practice Address - Phone:202-265-2343
Practice Address - Fax:202-248-9076
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA095101YA0400X
VA0718000097101YA0400X
DCPRC217101YP2500X
VA0701003368101YP2500X
MDLC0891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073693990Medicaid