Provider Demographics
NPI:1649222555
Name:WHEELER, SAMANTHA LORINE (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LORINE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 W. CHICAGO STREET
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49068
Mailing Address - Country:US
Mailing Address - Phone:517-279-8866
Mailing Address - Fax:517-279-8866
Practice Address - Street 1:694 W. CHICAGO STREET
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49068
Practice Address - Country:US
Practice Address - Phone:517-279-8866
Practice Address - Fax:517-279-8866
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015601103T00000X
IL071008438103TC0700X
MI68010842141041C0700X
IL149.0147581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical