Provider Demographics
NPI:1386751469
Name:WHEELER, CANDACE (LICSW)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 WASHINGTON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2044
Mailing Address - Country:US
Mailing Address - Phone:603-559-9912
Mailing Address - Fax:
Practice Address - Street 1:58 WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2044
Practice Address - Country:US
Practice Address - Phone:603-559-9912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1040821041C0700X
NH4691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3042382Medicaid
NH3042382Medicaid