Basic Information
| Provider Information | |||||||||
| NPI: | 1619078045 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHEELER | ||||||||
| FirstName: | PAULINE | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | LCDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 LANSING AVE | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028882661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014675435 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 CENTERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028860200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017325656 | ||||||||
| FaxNumber: | 4017388634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCDP 00000262 | RI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 62-88701 | 01 | RI | UBH | OTHER |