Provider Demographics
NPI:1285970509
Name:WHEEL, MELANIE (MS, LSATP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:WHEEL
Suffix:
Gender:F
Credentials:MS, LSATP
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCAS
Mailing Address - Street 1:4920 MILLRIDGE PKWY E STE 206
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4857
Mailing Address - Country:US
Mailing Address - Phone:804-464-8875
Mailing Address - Fax:
Practice Address - Street 1:4920 MILLRIDGE PKWY E STE 206
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4857
Practice Address - Country:US
Practice Address - Phone:804-464-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000257101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336293000Medicaid