Provider Demographics
NPI:1740695543
Name:WHEELBARGER, JEFFREY (LICDC - CS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:WHEELBARGER
Suffix:
Gender:M
Credentials:LICDC - CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10285 TUSCANY DR
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-7009
Mailing Address - Country:US
Mailing Address - Phone:614-504-5382
Mailing Address - Fax:
Practice Address - Street 1:1851 STATE ROUTE 56
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-0740
Practice Address - Country:US
Practice Address - Phone:740-852-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH981295101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)