MEDICARE: CARTER WHEELER SUMMERVILLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701010137	VA

General Provider Information

NPI Number	:	1013513274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARTER WHEELER SUMMERVILLE

Provider Business Mailing Address
First Line	:	382 FENTON MILL RD
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-1858
Country	:	US
Telephone Number	:	757-844-7192
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 RICHMOND RD STE 3300-304
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-7226
Country	:	US
Telephone Number	:	757-844-7192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2020
Last Update Date	:	04/22/2024

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