Provider Demographics
NPI:1811244015
Name:WHEATLEY, SALLY L (LPC)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:L
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 TODDS LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3160
Mailing Address - Country:US
Mailing Address - Phone:757-315-4200
Mailing Address - Fax:757-595-3286
Practice Address - Street 1:2236 TODDS LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3160
Practice Address - Country:US
Practice Address - Phone:757-315-4200
Practice Address - Fax:757-595-3286
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010321166Medicaid