Provider Demographics
NPI:1972738433
Name:WHEELER, ROBERT VERN (CDP NCACII, SAP)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:VERN
Last Name:WHEELER
Suffix:
Gender:M
Credentials:CDP NCACII, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 D ST STE 5
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3376
Mailing Address - Country:US
Mailing Address - Phone:360-696-3307
Mailing Address - Fax:360-695-1892
Practice Address - Street 1:1801 D ST STE 5
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3376
Practice Address - Country:US
Practice Address - Phone:360-696-3307
Practice Address - Fax:360-695-1892
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002013101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)