Provider Demographics
NPI:1811492994
Name:WHEELER, JASON J (MS/CAGS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:J
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MS/CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-1239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:KING GEORGE HIGH SCHOOL
Practice Address - Street 2:10100 FOXES WAY
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485
Practice Address - Country:US
Practice Address - Phone:540-775-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPGP-0673762103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool