Healthcare Provider Details

I. General information

NPI: 1548993132
Provider Name (Legal Business Name): PATRICIA WHIPPLE LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NORTH CT
ATLANTIC BEACH NC
28512-5800
US

IV. Provider business mailing address

105 NORTH CT
ATLANTIC BEACH NC
28512-5800
US

V. Phone/Fax

Practice location:
  • Phone: 252-723-0617
  • Fax:
Mailing address:
  • Phone: 252-723-0617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA17676
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: