Healthcare Provider Details

I. General information

NPI: 1710341276
Provider Name (Legal Business Name): SHAWNNA WHITING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 D ST STE G
MARYSVILLE CA
95901-5957
US

IV. Provider business mailing address

2209 PLAZA DR STE 100
ROCKLIN CA
95765-4419
US

V. Phone/Fax

Practice location:
  • Phone: 530-237-1715
  • Fax:
Mailing address:
  • Phone: 888-922-2843
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1224060316
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: