Provider Demographics
NPI:1669789319
Name:WHEELER WIGGINS, P.A.
Entity type:Organization
Organization Name:WHEELER WIGGINS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARTER
Authorized Official - Middle Name:TYRONE
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, SAP
Authorized Official - Phone:305-825-5698
Mailing Address - Street 1:1175 NE 125TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5015
Mailing Address - Country:US
Mailing Address - Phone:305-825-5698
Mailing Address - Fax:305-895-1737
Practice Address - Street 1:4330 W BROWARD BLVD
Practice Address - Street 2:SUITE R
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3775
Practice Address - Country:US
Practice Address - Phone:305-825-5698
Practice Address - Fax:305-895-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL80292101YA0400X
FLSW43481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000109300Medicaid
FLZ7316ZMedicare PIN