Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 38772 | TX |
NPI | 1124436530 |
---|---|
Provider Name | Alicia Wheelington |
First Address | Dallas, TX 75235-7701 |
Second Address | Fayetteville, AR 72703-4591 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2014 |
Last Update Date | 12/10/2021 |