Provider Demographics
NPI:1801614953
Name:WISE, WESLEY CHASE (LPC)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:CHASE
Last Name:WISE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-3354
Mailing Address - Country:US
Mailing Address - Phone:256-777-7024
Mailing Address - Fax:
Practice Address - Street 1:526 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-3354
Practice Address - Country:US
Practice Address - Phone:256-777-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC04575101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor