Provider Demographics
NPI:1053733048
Name:WHEELESS, PAMELA MARIE (LCPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:WHEELESS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4825
Mailing Address - Country:US
Mailing Address - Phone:443-520-6771
Mailing Address - Fax:
Practice Address - Street 1:629 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4825
Practice Address - Country:US
Practice Address - Phone:443-520-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1736101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional