Provider Demographics
NPI:1710227459
Name:WHEELER, CYNTHIA A (LICSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 SEMINOLE BLVD 100
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-5935
Mailing Address - Country:US
Mailing Address - Phone:603-396-9374
Mailing Address - Fax:
Practice Address - Street 1:7130 SEMINOLE BLVD 100
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-5935
Practice Address - Country:US
Practice Address - Phone:603-396-9374
Practice Address - Fax:727-399-1715
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical