Provider Demographics
NPI:1609416767
Name:WHEELER, HADASSAH REBEKAH
Entity Type:Individual
Prefix:
First Name:HADASSAH
Middle Name:REBEKAH
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 1:100 PHOENIX LN NW APT O
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7580
Mailing Address - Country:US
Mailing Address - Phone:412-313-3673
Mailing Address - Fax:
Practice Address - Street 1:1619 COLLINS RD NW STE 500
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-8237
Practice Address - Country:US
Practice Address - Phone:188-509-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician