Provider Demographics
NPI:1699901819
Name:ROB WHEELER LCSW, P.A.
Entity type:Organization
Organization Name:ROB WHEELER LCSW, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:1252-299-2226
Mailing Address - Street 1:2102 DEES CT NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1462
Mailing Address - Country:US
Mailing Address - Phone:125-229-9222
Mailing Address - Fax:
Practice Address - Street 1:2404 MONTGOMERY DR SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4462
Practice Address - Country:US
Practice Address - Phone:125-229-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0048641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003174Medicaid
194800OtherMED COST
NC139EUOtherBLUE CROSS AND BLUE SHIELD
NC419749OtherTRI CARE
NC6003174Medicaid