Provider Demographics
NPI:1871570523
Name:WHEELER, CINDY J (LMSW, ACSW, CAC-R)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:J
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LMSW, ACSW, CAC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1010
Mailing Address - Country:US
Mailing Address - Phone:906-482-1193
Mailing Address - Fax:
Practice Address - Street 1:900 BIRCH ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1010
Practice Address - Country:US
Practice Address - Phone:906-482-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010771521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
EO26040024Medicare ID - Type Unspecified