Provider Demographics
NPI:1396089421
Name:WHEELER, KIMBERLY DONNIELLE (LCSW-C)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:DONNIELLE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 BAINBRIDGE ST
Mailing Address - Street 2:APT 1R
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2323
Mailing Address - Country:US
Mailing Address - Phone:443-851-8258
Mailing Address - Fax:
Practice Address - Street 1:234 BAINBRIDGE ST
Practice Address - Street 2:APT 1R
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-2323
Practice Address - Country:US
Practice Address - Phone:443-851-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD152261041C0700X
PACW0175151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical