Provider Demographics
NPI:1396116059
Name:WHEELER, STEPHANIE LOUISE (MSW, LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LOUISE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MSW, LCSW, LCADC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LOUISE
Other - Last Name:NAUTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW, LCADC
Mailing Address - Street 1:700 24TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:VA
Mailing Address - Zip Code:23801-1716
Mailing Address - Country:US
Mailing Address - Phone:804-734-9227
Mailing Address - Fax:804-734-9188
Practice Address - Street 1:700 24TH ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1716
Practice Address - Country:US
Practice Address - Phone:804-734-9227
Practice Address - Fax:804-734-9188
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00098100101YA0400X
NJ00354479101YS0200X
NJ003584811041S0200X
NJ44SC052309001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool