Provider Demographics
NPI:1578920039
Name:WISE, CHOYA (LCSW, PIP)
Entity Type:Individual
Prefix:
First Name:CHOYA
Middle Name:
Last Name:WISE
Suffix:
Gender:M
Credentials:LCSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6275 UNIVERSITY BOULEVARD
Mailing Address - Street 2:STE 37 #251
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806
Mailing Address - Country:US
Mailing Address - Phone:256-434-1246
Mailing Address - Fax:
Practice Address - Street 1:1955 RIDEOUT DR NW
Practice Address - Street 2:STE 400
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-1672
Practice Address - Country:US
Practice Address - Phone:256-434-1246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2305C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical