Provider Demographics
NPI:1023484474
Name:WHEATLEY, REGINA BRAMER (LCSW)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:BRAMER
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:WHEATLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1519 BAXTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205
Mailing Address - Country:US
Mailing Address - Phone:502-409-7181
Mailing Address - Fax:502-409-7181
Practice Address - Street 1:914 LILY CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2815
Practice Address - Country:US
Practice Address - Phone:502-805-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY17981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical