Provider Demographics
NPI:1134152135
Name:GILEAD FANILY SERVICES GROUP, LLC
Entity type:Organization
Organization Name:GILEAD FANILY SERVICES GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:202-723-1515
Mailing Address - Street 1:930 KENNEDY ST NW
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2916
Mailing Address - Country:US
Mailing Address - Phone:202-723-1515
Mailing Address - Fax:
Practice Address - Street 1:930 KENNEDY ST NW
Practice Address - Street 2:SUITE 350
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2916
Practice Address - Country:US
Practice Address - Phone:202-723-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3035781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty