Healthcare Provider Details

I. General information

NPI: 1710230412
Provider Name (Legal Business Name): DAVID WAYNE WHEELER LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 GARNER FIELD RD
UVALDE TX
78801-6209
US

IV. Provider business mailing address

371 MADRONA DR
KERRVILLE TX
78028-8629
US

V. Phone/Fax

Practice location:
  • Phone: 830-591-1822
  • Fax: 830-591-1826
Mailing address:
  • Phone: 830-879-3047
  • Fax: 830-879-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2355
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: