Provider Demographics
NPI:1518247493
Name:WHEELER, VICKI R (LPC, CAADC, CCJP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:R
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LPC, CAADC, CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 STONEGATE RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-1597
Mailing Address - Country:US
Mailing Address - Phone:717-751-6412
Mailing Address - Fax:
Practice Address - Street 1:2159 WHITE ST STE 17
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-4950
Practice Address - Country:US
Practice Address - Phone:717-751-6412
Practice Address - Fax:717-751-6412
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005424101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional