Provider Demographics
NPI:1689347551
Name:WHEELER, DIALIS BURKE (LMHC,NCC)
Entity Type:Individual
Prefix:MRS
First Name:DIALIS
Middle Name:BURKE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LMHC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 120695
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-0012
Mailing Address - Country:US
Mailing Address - Phone:954-295-0678
Mailing Address - Fax:
Practice Address - Street 1:4629 NW 9TH DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1480
Practice Address - Country:US
Practice Address - Phone:954-295-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19478101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health