Provider Demographics
NPI:1306652102
Name:WHEELER, KERRI JEAN (MA, CAS, NCSP)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:JEAN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MA, CAS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 N RIDGE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3463
Mailing Address - Country:US
Mailing Address - Phone:757-288-8389
Mailing Address - Fax:
Practice Address - Street 1:2850 N RIDGE RD STE 208
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3463
Practice Address - Country:US
Practice Address - Phone:757-288-8389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3220103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool