Provider Demographics
NPI:1649513532
Name:WHEELER, THERESA LYNN (LPC/S, LAC/S, MA, CS)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LYNN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LPC/S, LAC/S, MA, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 PELHAM RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4182
Mailing Address - Country:US
Mailing Address - Phone:864-664-2764
Mailing Address - Fax:864-738-7106
Practice Address - Street 1:3519 PELHAM RD STE 105
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4182
Practice Address - Country:US
Practice Address - Phone:864-664-2764
Practice Address - Fax:864-738-7106
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC187101YA0400X
SC5271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3OtherLACS
SC187OtherLAC
SC19111253OtherCLINICAL SUPERVISOR
SC5271OtherLPC
SC6398OtherLPCS