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General NPI Number Information
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NPI Number | 1912387697
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Entity Type | Organization
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Legal Business Name | JASON S WHEATLEY
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 2483 S LINDEN RD STE 240
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City | FLINT
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State | MI
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Zip | 48532-5478
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Country | US
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Telephone | 810-493-2935
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Fax |
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Provider Business Mailing Address
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Address Line | 2469 MIAMI BEACH DR
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City | FLINT
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State | MI
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Zip | 48507-1051
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JASON WHEATLEY
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Credential | LMSW
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Telephone | 810-347-8143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801086655
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License Number State | MI
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